1851396485 NPI number — HEALTHTEXAS PROVIDER NETWORK

Table of content: (NPI 1851396485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851396485 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:
1851396485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2013
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:
STE 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:
4708 ALLIANCE BLVD
Provider Second Line Business Practice Location Address:
STE 270
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-826-6276
Provider Business Practice Location Address Fax Number:
214-826-6223
Provider Enumeration Date:
06/20/2005

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: 208600000X , with the licence number:  00363X , 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)

  • Identifier: 1688814-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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