Individual ProviderJared CriswellFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1500 S Main St, Fort Worth, TX 76104-4917(817) 702-34311770229778PECOS EnrollmentBased on the most recent information from CMS, provider Jared Criswell is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1265896146Provider TypeIndividualFull NameCriswell, JaredCredentialM.D.GenderMaleSole ProprietorYesEnumeration Date4/7/2016Last Updated7/30/2020Contact InformationPractice LocationPractice Address1500 S Main St, Fort Worth, TX 76104-4917Phone(817) 702-3431FaxUnlisted FaxMailing LocationMailing Address200 W Magnolia Ave Ste 201, Fort Worth, TX 76104-7657Phone1770229778Fax(817) 702-2140Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseR8340TexasCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer