MEDICARE: COUNTY OF TARRANT

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	172V00000X	Community Health Worker
2	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1245413475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF TARRANT

Provider Business Mailing Address
First Line	:	1101 S MAIN ST
Second Line	:	SUITE 2106
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4700
Fax Number	:	817-850-5845

Provider Business Practice Location Address
First Line	:	1101 S MAIN ST
Second Line	:	SUITE 2106
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4700
Fax Number	:	817-850-5845

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CATHERINE A COLQUITT
Credential	:	M.D.
Telephone Number	:	817-321-4816

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	05/03/2017

Similar Medicare Providers

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Practice Location Address:

1101 S MAIN ST
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76104-4802

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1932125598 — GLENDA MARIE REDEEMER RN
Practice Location Address:

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1932370863 — MRS. HEATHER LYNN MCMANUS F.N.P.
Practice Location Address:

1101 S MAIN ST
FORT WORTH, TX
76104-4802

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1942449178 — SVEA LYNN BRYAN LVN
Practice Location Address:

1101 S. MAIN STREET , SUITE 1500
FORT WORTH, TX
76104-4802

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1326287012 — MRS. SHERYL LYNN WILLYERD RN
Practice Location Address:

1101 S MAIN ST , SUITE 1500
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Practice Fax:

1942434758 — MRS. DEBORAH RADAFORD FNP-C, AAHIVMS
Practice Location Address:

1101 S MAIN ST , ROOM 1500
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Practice Phone: 817-321-4850
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Directions to “COUNTY OF TARRANT ” Practice Location

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