Provider Demographics
NPI:1194783183
Name:COUNTY OF TARRANT
Entity type:Organization
Organization Name:COUNTY OF TARRANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLQUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-321-5344
Mailing Address - Street 1:1101 S MAIN ST # 2106
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4802
Mailing Address - Country:US
Mailing Address - Phone:817-321-4700
Mailing Address - Fax:817-850-5845
Practice Address - Street 1:1101 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-321-4700
Practice Address - Fax:817-850-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174H00000X, 2083P0901X, 251K00000X, 174400000X
TX45D0659873291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083149703Medicaid
TX083149704Medicaid
TX083149703Medicaid
TX083149704Medicaid
TXPH0004Medicare PIN
TX00J32TMedicare PIN
TX083149703Medicaid
TX022817305Medicaid
TX022817307Medicaid
TXPH0004Medicare PIN