Provider Demographics
NPI:1689789760
Name:GASTROENTEROLOGY AND ENDOSCOPY ASSOCIATES OF FORT WORTH, P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND ENDOSCOPY ASSOCIATES OF FORT WORTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATARAJ
Authorized Official - Middle Name:G
Authorized Official - Last Name:KASAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-926-9087
Mailing Address - Street 1:6300 RIDGLEA PL STE 1103
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5737
Mailing Address - Country:US
Mailing Address - Phone:817-926-9087
Mailing Address - Fax:817-924-1268
Practice Address - Street 1:6300 RIDGLEA PL STE 1103
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5737
Practice Address - Country:US
Practice Address - Phone:817-926-9087
Practice Address - Fax:817-924-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5808207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCD3144OtherMEDICARE RAILROAD
TX0856858-01Medicaid
TX4037687OtherAETNA PROV ID #
TXB23851Medicare UPIN
TX4037687OtherAETNA PROV ID #