MEDICARE: TARRANT COUNTY GERIATRIC ASSOCIATES

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	363LF0000X	Family Nurse Practitioner	533712	TX
2	207Q00000X	Family Medicine Physician	J6652	TX

General Provider Information

NPI Number	:	1942412457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT COUNTY GERIATRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 126334
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-0334
Country	:	US
Telephone Number	:	817-249-6590
Fax Number	:	817-249-6595

Provider Business Practice Location Address
First Line	:	8575 MIAMI SPRINGS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1478
Country	:	US
Telephone Number	:	817-249-6590
Fax Number	:	817-249-6595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DEL S PERRY
Credential	:	FNP-C
Telephone Number	:	817-249-6590

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	03/20/2008

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