=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669701546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYNET, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2009
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 N MAIN ST
-----------------------------------------------------
City | LONE STAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75668-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-656-0633
-----------------------------------------------------
Fax | 309-656-0636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4002 TECHNOLOGY CTR
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75605-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-247-0484
-----------------------------------------------------
Fax | 903-247-0485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOHN D FORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-247-0484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------