Provider Demographics
NPI:1205806106
Name:TARRANT FAMILY PRACTICE P.A
Entity type:Organization
Organization Name:TARRANT FAMILY PRACTICE P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-236-3622
Mailing Address - Street 1:251 WESTPARK WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3742
Mailing Address - Country:US
Mailing Address - Phone:682-236-3622
Mailing Address - Fax:817-545-8952
Practice Address - Street 1:4504 BOAT CLUB RD
Practice Address - Street 2:SUITE 800
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7003
Practice Address - Country:US
Practice Address - Phone:817-237-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A97JMedicare ID - Type Unspecified
TX081597902Medicaid
TX081597903Medicaid