1770764458 NPI number — TEXAS HEALTH QUEST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770764458 NPI number — TEXAS HEALTH QUEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HEALTH QUEST
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:
TEXAS HEALTH QUEST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770764458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 RUFE SNOW DR
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
WATAUGA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76148-2348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-656-1615
Provider Business Mailing Address Fax Number:
817-428-0573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 RUFE SNOW DR
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
WATAUGA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76148-2348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-656-1615
Provider Business Practice Location Address Fax Number:
817-428-0573
Provider Enumeration Date:
11/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-656-1615

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC4083 , 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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