Provider Demographics
NPI:1720005523
Name:GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS, LLP
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NORTH TEXAS, LLP
Other - Org Name:GANT
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-870-7300
Mailing Address - Street 1:900 W MAGNOLIA AVE STE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8518
Mailing Address - Country:US
Mailing Address - Phone:817-870-7300
Mailing Address - Fax:817-332-8372
Practice Address - Street 1:900 W MAGNOLIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8518
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-332-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085307902Medicaid
TX085307902Medicaid