Healthcare Provider Details

I. General information

NPI: 1831661412
Provider Name (Legal Business Name): SPECIAL HEALTH RESOURCES FOR TEXAS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 GALLERIA OAKS DR
TEXARKANA TX
75503-4617
US

IV. Provider business mailing address

PO BOX 2709
LONGVIEW TX
75606-2709
US

V. Phone/Fax

Practice location:
  • Phone: 903-792-0308
  • Fax: 903-792-0007
Mailing address:
  • Phone: 903-234-0776
  • Fax: 903-234-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KIM DALE NESVIG
Title or Position: CEO
Credential:
Phone: 903-234-0776