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General NPI Number Information
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NPI Number | 1619265121
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Entity Type | Organization
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Legal Business Name | COUNTY OF TARRANT
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 1101 S MAIN ST SUITE 2106
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City | FORT WORTH
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State | TX
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Zip | 76104-4802
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Country | US
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Telephone | 817-321-4769
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Fax | 817-850-5845
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Provider Business Mailing Address
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Address Line | 1101 S MAIN ST SUITE 2106
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City | FORT WORTH
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State | TX
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Zip | 76104-4802
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Country | US
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Telephone | 817-321-4700
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Fax | 817-850-5845
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CATHERINE A COLQUITT
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Credential | M.D.
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Telephone | 817-321-5344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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