Healthcare Provider Details

I. General information

NPI: 1154325850
Provider Name (Legal Business Name): OMEGA OB-GYN ASSOCIATES OF SOUTH ARLINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MATLOCK RD STE 350
ARLINGTON TX
76015-2954
US

IV. Provider business mailing address

3201 MATLOCK RD STE 350
ARLINGTON TX
76015-2954
US

V. Phone/Fax

Practice location:
  • Phone: 817-468-3255
  • Fax: 817-468-7823
Mailing address:
  • Phone: 817-468-3255
  • Fax: 817-468-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN R GORDON JR.
Title or Position: PARTNER
Credential: M.D.
Phone: 817-468-3255