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NPI Code Detail

MEDICARE: HEALTHTEXAS PROVIDER NETWORK-TRANSPLANT SERVICES LLP

MEDICARE: HEALTHTEXAS PROVIDER NETWORK-TRANSPLANT SERVICES LLP
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
1208600000XSurgery Physician00740UTX
2204F00000XTransplant Surgery Physician00740UTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20078JQOTHERTXBCBSTX

General Provider Information

NPI Number : 1881699460
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHTEXAS PROVIDER NETWORK-TRANSPLANT SERVICES LLP
Provider Business Mailing Address
First Line : 8080 N CENTRAL EXPY
Second Line : STE 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 : 3500 GASTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75246-2096
Country : US
Telephone Number : 214-820-2050
Fax Number : 972-860-8601
Authorized Official
Title or Position : DIRECTOR
Name : MRS. ELLEN ELIZABETH FOURTON
Credential :
Telephone Number : 972-860-8649
Provider Enumeration Date : 06/20/2005
Last Update Date : 04/21/2010

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Directions to “HEALTHTEXAS PROVIDER NETWORK-TRANSPLANT SERVICES LLP ” Practice Location

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