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General NPI Number Information
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NPI Number | 1790782654
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Entity Type | Organization
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Legal Business Name | HEALTHTEXAS PROVIDER NETWORK-TRANSPLANT SERVICES LLP
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 1400 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4110
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Country | US
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Telephone | 817-922-4650
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Fax | 817-922-4655
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 00732U
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 00732U
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License Number State | TX
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