Healthcare Provider Details

I. General information

NPI: 1487226791
Provider Name (Legal Business Name): HEALTH TEXAS PROVIDER NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 ALLIANCE BLVD STE 210
PLANO TX
75093-5554
US

IV. Provider business mailing address

301 N WASHINGTON AVE
DALLAS TX
75246-1754
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-4770
  • Fax:
Mailing address:
  • Phone: 214-865-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE J TELFORD
Title or Position: MANAGED CARE CONSULTANT
Credential:
Phone: 469-800-8648