1871598458 NPI number — HEALTHTEXAS PROVIDER NETWORK - WAXAHACHIE SURGICAL SPECIALIST, LLP

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 1871598458 NPI number — HEALTHTEXAS PROVIDER NETWORK - WAXAHACHIE SURGICAL SPECIALIST, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHTEXAS PROVIDER NETWORK - WAXAHACHIE SURGICAL SPECIALIST, 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:
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:
1871598458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8060 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
STE 1650
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-1801
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:
1505 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
STE 165
Provider Business Practice Location Address City Name:
WAXAHACHIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75165-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-923-1457
Provider Business Practice Location Address Fax Number:
972-923-1304
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:  00863W , 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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