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General NPI Number Information
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NPI Number | 1083858831
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Entity Type | Organization
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Legal Business Name | TEXARKANA REGIONAL HEALTHCARE NETWORK
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 1000 PINE ST
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City | TEXARKANA
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State | TX
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Zip | 75501-5100
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Country | US
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Telephone | 903-798-7317
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Fax | 903-798-7377
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Provider Business Mailing Address
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Address Line | PO BOX 847045
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City | DALLAS
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State | TX
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Zip | 75284-7045
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Country | US
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Telephone | 866-724-6662
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Fax | 314-432-9386
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN A DEMKE
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Credential |
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Telephone | 615-467-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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