Healthcare Provider Details

I. General information

NPI: 1346203528
Provider Name (Legal Business Name): HEALTHTEXAS PROVIDER NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 ALLIANCE BLVD
PLANO TX
75093-5337
US

IV. Provider business mailing address

4708 ALLIANCE BLVD
PLANO TX
75093-5337
US

V. Phone/Fax

Practice location:
  • Phone: 972-758-4950
  • Fax: 972-758-4955
Mailing address:
  • Phone: 972-758-4950
  • Fax: 972-758-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number008136
License Number StateTX

VIII. Authorized Official

Name: MRS. LINDA ZAHN
Title or Position: ADMINISTRATOR
Credential:
Phone: 972-758-4953