Healthcare Provider Details

I. General information

NPI: 1407800857
Provider Name (Legal Business Name): TEXOMACARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BROOKSIDE DR
MADILL OK
73446-3643
US

IV. Provider business mailing address

5012 US HWY 75 S, SUITE 300 ATT: BILLING
DENISON TX
75020
US

V. Phone/Fax

Practice location:
  • Phone: 580-795-5506
  • Fax: 580-795-5145
Mailing address:
  • Phone: 903-416-1726
  • Fax: 903-416-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD EVANS
Title or Position: VP
Credential:
Phone: 610-768-3300