Fort Worth Proctologic Clinic, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

E1124 Issued in TX

Legal business name

FORT WORTH PROCTOLOGIC CLINIC, PA

Practice address

1050 W Rosedale St
Fort Worth, TX 76104-4422

Phone

(817) 338-4501

Fax

(817) 338-4503

NPI assigned

Dec 31, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sommai Sehapayak, M.D.

Title

Owner

Phone

(817) 338-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Georgina Kerlakian Sehapayak, M.D.

  • Cardiovascular Disease Physician
  • Fort Worth, TX
  • NPI 1427010776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262217600000",
    "number": "1710217435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W ROSEDALE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044422",
            "telephone_number": "817-338-4501",
            "fax_number": "817-338-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W ROSEDALE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044422",
            "telephone_number": "817-338-4501",
            "fax_number": "817-338-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH PROCTOLOGIC CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-31",
        "last_updated": "2009-12-31",
        "status": "A",
        "authorized_official_last_name": "SEHAPAYAK",
        "authorized_official_first_name": "SOMMAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-338-4501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "E1124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099907001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Fort Worth Psychworks, PLLC
• Fort Worth Radiology, PLLC
• Fort Worth Recovery LLC
• Fort Worth Rehab Group
• Fort Worth Senior Care, LLC

• Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.