Provider Demographics
NPI:1063906964
Name:NORTH TARRANT HEALTH PROVIDERS PLLC
Entity type:Organization
Organization Name:NORTH TARRANT HEALTH PROVIDERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BALAGURU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBANDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-717-5268
Mailing Address - Street 1:1540 KELLER PKWY STE 108-249
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3686
Mailing Address - Country:US
Mailing Address - Phone:817-717-5268
Mailing Address - Fax:817-717-8021
Practice Address - Street 1:3025 N TARRANT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8625
Practice Address - Country:US
Practice Address - Phone:817-717-5268
Practice Address - Fax:817-717-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty