MEDICARE: HEALTHTEXAS PROVIDER NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	00348T	TX
2	207V00000X	Obstetrics & Gynecology Physician	00348T	TX
3	207Q00000X	Family Medicine Physician	00348T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0092HQ	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003811639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHTEXAS PROVIDER NETWORK

Provider Business Mailing Address
First Line	:	301 N WASHINGTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1754
Country	:	US
Telephone Number	:	469-800-8742
Fax Number	:	469-800-8679

Provider Business Practice Location Address
First Line	:	1820 PRESTON PARK BLVD STE 1450
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3691
Country	:	US
Telephone Number	:	469-800-4540
Fax Number	:	469-800-4541

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. JENNIFER S. REEVES
Credential	:
Telephone Number	:	214-865-2753

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/06/2025

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Directions to “HEALTHTEXAS PROVIDER NETWORK ” Practice Location

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