MEDICARE: FAMILY GERIATRICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	K1776	TX

General Provider Information

NPI Number	:	1053584755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY GERIATRICS PA

Provider Business Mailing Address
First Line	:	PO BOX 822426
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-2426
Country	:	US
Telephone Number	:	817-605-1707
Fax Number	:	817-605-1710

Provider Business Practice Location Address
First Line	:	5348 DAVIS BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6824
Country	:	US
Telephone Number	:	817-605-1707
Fax Number	:	817-605-1710

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET C BASILIADIS
Credential	:	D.O.
Telephone Number	:	817-605-1707

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	10/15/2008

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