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General NPI Number Information
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NPI Number | 1376541193
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Entity Type | Organization
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Legal Business Name | HEALTHTEXAS PROVIDER NETWORK
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 3600 GASTON AVE SUITE 1101
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City | DALLAS
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State | TX
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Zip | 75246-1800
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Country | US
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Telephone | 214-820-7010
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Fax | 214-820-7015
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Provider Business Mailing Address
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Address Line | 8080 N CENTRAL EXPY SUITE 600, LB82
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City | DALLAS
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State | TX
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Zip | 75206-1838
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Country | US
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Telephone | 972-860-8648
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Fax | 972-860-8679
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ELLEN ELIZABETH FOURTON
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Credential |
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Telephone | 972-860-8649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 00955K
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 00955K
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 00955K
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 00955K
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 00955K
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 00955K
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 00955K
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License Number State | TX
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