1821241605 NPI number — HEALTHTEXAS PROVIDER NETWORK

Table of content: (NPI 1821241605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821241605 NPI number — HEALTHTEXAS PROVIDER NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHTEXAS PROVIDER NETWORK
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:
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:
1821241605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
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 600, LB82
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:
972-860-8648
Provider Business Mailing Address Fax Number:
972-860-8679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-8517
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:
10/24/2008

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0077DJ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200663701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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