1114919172 NPI number — HEALTH TEXAS PROVIDER NETWORK-FAMILY PRACTICE OF NORTH TEXAS LLP

Table of content: (NPI 1114919172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114919172 NPI number — HEALTH TEXAS PROVIDER NETWORK-FAMILY PRACTICE OF NORTH TEXAS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH TEXAS PROVIDER NETWORK-FAMILY PRACTICE OF NORTH TEXAS LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1114919172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 1650
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-860-8653
Provider Business Mailing Address Fax Number:
972-860-8679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-921-6166
Provider Business Practice Location Address Fax Number:
817-921-9594
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOURTON
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
972-860-8649

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  00997Y , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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