Provider Demographics
NPI:1497038632
Name:TARRANT GASTROENTEROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:TARRANT GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGASAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-877-0200
Mailing Address - Street 1:3020 BELLAIRE RANCH DR APT 1517
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1843
Mailing Address - Country:US
Mailing Address - Phone:817-877-0200
Mailing Address - Fax:817-877-0203
Practice Address - Street 1:1111 5TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4302
Practice Address - Country:US
Practice Address - Phone:817-877-0200
Practice Address - Fax:817-877-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty