MEDICARE: GASTROENTEROLOGY AND ENDOSCOPY ASSOCIATES OF FORT WORTH, P.A.

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	207RG0100X	Gastroenterology Physician	E5808	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD3144	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4037687	OTHER	TX	AETNA PROV ID #

General Provider Information

NPI Number	:	1689789760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY AND ENDOSCOPY ASSOCIATES OF FORT WORTH, P.A.

Provider Business Mailing Address
First Line	:	6300 RIDGLEA PL STE 1103
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5737
Country	:	US
Telephone Number	:	817-926-9087
Fax Number	:	817-924-1268

Provider Business Practice Location Address
First Line	:	6300 RIDGLEA PL STE 1103
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5737
Country	:	US
Telephone Number	:	817-926-9087
Fax Number	:	817-924-1268

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NATARAJ G. KASAL
Credential	:	MD
Telephone Number	:	817-926-9087

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	02/08/2013

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