Provider Demographics
NPI:1528220654
Name:NORTH TEXAS TRIANGLE GASTROENTEROLOGY GROUP LTD LLP
Entity Type:Organization
Organization Name:NORTH TEXAS TRIANGLE GASTROENTEROLOGY GROUP LTD LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GANG
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-399-6691
Mailing Address - Street 1:2900 N INTERSTATE 35 STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5142
Mailing Address - Country:US
Mailing Address - Phone:214-394-6691
Mailing Address - Fax:940-898-8247
Practice Address - Street 1:2900 N INTERSTATE 35 STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5142
Practice Address - Country:US
Practice Address - Phone:214-394-6691
Practice Address - Fax:940-898-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4662261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151200603Medicaid
H60266Medicare UPIN