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General NPI Number Information
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NPI Number | 1063906964
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Entity Type | Organization
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Legal Business Name | NORTH TARRANT HEALTH PROVIDERS PLLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 3025 N TARRANT PKWY STE 100
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City | FORT WORTH
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State | TX
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Zip | 76177-8625
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Country | US
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Telephone | 817-717-5268
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Fax | 817-717-8021
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Provider Business Mailing Address
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Address Line | 1540 KELLER PKWY STE 108-249
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City | KELLER
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State | TX
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Zip | 76248-3686
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Country | US
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Telephone | 817-717-5268
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Fax | 817-717-8021
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Authorized Official
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Title or Position | OWNER
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Name | DR. BALAGURU SAMBANDAM
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Credential | MD
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Telephone | 817-717-5268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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