MEDICARE: HEALTHTEXAS PROVIDER NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	00955K	TX
2	207T00000X	Neurological Surgery Physician	00955K	TX
3	207XX0801X	Orthopaedic Trauma Physician	00955K	TX
4	2085R0001X	Radiation Oncology Physician	00955K	TX
5	2084N0400X	Neurology Physician	00955K	TX
6	207Y00000X	Otolaryngology Physician	00955K	TX
7	207X00000X	Orthopaedic Surgery Physician	00955K	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0077DJ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1376541193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHTEXAS PROVIDER NETWORK

Provider Business Mailing Address
First Line	:	8080 N CENTRAL EXPY
Second Line	:	SUITE 600, LB82
City	:	DALLAS
State	:	TX
Zip	:	75206-1838
Country	:	US
Telephone Number	:	972-860-8648
Fax Number	:	972-860-8679

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 1101
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-820-7010
Fax Number	:	214-820-7015

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ELLEN ELIZABETH FOURTON
Credential	:
Telephone Number	:	972-860-8649

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/04/2011

Similar Medicare Providers

1508861527 — DR. GEORGE JACKSON SNIPES JR. M.D.
Practice Location Address:

3600 GASTON AVE , WADLEY TOWER, #261
DALLAS, TX
75246-1800

Practice Phone: 214-823-6492
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1871592485 — MARK LESHIN MD
Practice Location Address:

3600 GASTON AVE , #1160
DALLAS, TX
75246-1800

Practice Phone: 214-828-1276
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1295736437 — DR. JOHN MICHAEL JORDAN M.D.
Practice Location Address:

3600 GASTON AVE , SUITE 806
DALLAS, TX
75246-1800

Practice Phone: 214-824-8521
Practice Fax:

1225028988 — ANNAH M KING OTR/L, CHT
Practice Location Address:

3600 GASTON AVE , SUITE 450
DALLAS, TX
75246-1800

Practice Phone: 214-823-5351
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1174508311 — DR. MARYAM ZAMANIAN MD
Practice Location Address:

3600 GASTON AVE , SUITE 454
DALLAS, TX
75246-1800

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1144208836 — PHILIP B. HALLORAN, MD
Practice Location Address:

3600 GASTON AVE , SUITE 701
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75246-1800

Practice Phone: 214-823-6340
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Directions to “HEALTHTEXAS PROVIDER NETWORK ” Practice Location

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