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General NPI Number Information
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NPI Number | 1942206024
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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 | 06/23/2005
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 3409 WORTH ST SUITE 640
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City | DALLAS
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State | TX
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Zip | 75246-2029
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Country | US
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Telephone | 214-826-6276
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Fax | 214-826-6223
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Provider Business Mailing Address
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Address Line | 8080 N CENTRAL EXPY STE 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 | 00837T
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License Number State | TX
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