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General NPI Number Information
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NPI Number | 1841629573
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Entity Type | Organization
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Legal Business Name | NORTHWEST TEXAS PHYSICIAN GROUP
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 1501 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79106-1770
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Country | US
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Telephone | 610-768-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 367 S GULPH RD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3121
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Country | US
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Telephone | 610-768-3300
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JOHN JOHANNESSEN
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Credential |
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Telephone | 610-768-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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