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BOAT CLUB MEDICAL
NPI 1720473846
Specialist in Ft Worth, TX

Active since April 06, 2015CLIA 45D2160537 · Waiver
3963 BOAT CLUB RD, FT WORTH, TX 76135(817) 917-2630 Get Directions Write a Review

NPPES record last updated: April 6, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Boat Club Medical NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOAT CLUB MEDICAL (NPI 1720473846) is a healthcare organization registered as a specialist in Ft Worth, Texas and active in the NPI registry since April 2015. The organization holds a CLIA Waiver certificate valid through January 13, 2027 and lists Jerry Thomas Davis, Provider/owner, as its authorized official.

NPPES Registry Identity

NPI1720473846
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBOAT CLUB MEDICAL
Location Address3963 BOAT CLUB RDFt Worth, TX 76135-3202
Mailing Address3963 Boat Club RdFt Worth, TX 76135-3202
Phone(817) 917-2630
Organization SubpartNo
Authorized OfficialJerry Thomas DavisProvider/owner · (817) 917-2630
Enumeration DateApril 6, 2015
✔ NPI 1720473846 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in TX · F9351
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

3963 BOAT CLUB RD, Ft Worth, TX 76135
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2160537

Boat Club Medical · Fort Worth, TX
Active · expires Jan 13, 2027
CLIA Number45D2160537
Laboratory TypePhysician Office
Certificate Effective DateJanuary 14, 2025
Certificate Expiration DateJanuary 13, 2027
Laboratory DirectorJerry Davis
Laboratory Phone(817) 237-8502
Laboratory LocationBoat Club Medical3963 Boat Club Rd, Fort Worth, TX 76135
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER LYNN DEAKINS O.D.
Optometrist
3963 BOAT CLUB RD
FORT WORTH, TX 76135
Tarrant County (817) 237-7153
MATT MILLER OD PA
Optometrist
3963 BOAT CLUB RD
FORT WORTH, TX 76135
Tarrant County (817) 237-7153
DR. KENDRA L. DEBERRY O.D.
Optometrist
3963 BOAT CLUB RD
FORT WORTH, TX 76135
Tarrant County (817) 237-7153
AUSTIN TANNER GRAHAM BCBA
Behavior Analyst
3963 BOAT CLUB RD
LAKE WORTH, TX 76135
Tarrant County (214) 628-5726

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Boat Club Medical's NPI number?

The NPI number for Boat Club Medical is 1720473846. It was assigned to this organization in the NPPES registry on April 6, 2015.

Where is Boat Club Medical located?

Boat Club Medical is located at 3963 Boat Club Rd, Ft Worth, TX 76135. The listed phone number is (817) 917-2630.

What is Boat Club Medical's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Boat Club Medical hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2160537) is associated with this NPI, valid through January 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Boat Club Medical was last updated on April 6, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.