Provider Demographics
NPI:1053584755
Name:FAMILY GERIATRICS PA
Entity type:Organization
Organization Name:FAMILY GERIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BASILIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-605-1707
Mailing Address - Street 1:PO BOX 822426
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-2426
Mailing Address - Country:US
Mailing Address - Phone:817-605-1707
Mailing Address - Fax:817-605-1710
Practice Address - Street 1:5348 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6824
Practice Address - Country:US
Practice Address - Phone:817-605-1707
Practice Address - Fax:817-605-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1776207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00814NMedicare PIN