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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G4495	OTHER	TX	BCBS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063630937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHTEXAS PROVIDER NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 844128
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-2148
Country	:	US
Telephone Number	:	469-800-3524
Fax Number	:	469-800-3564

Provider Business Practice Location Address
First Line	:	6257 FM 2642 BLVD
Second Line	:	SUITE 100
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-3223
Country	:	US
Telephone Number	:	469-800-3670
Fax Number	:	469-800-3680

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	TONIE HALL
Credential	:
Telephone Number	:	469-800-3670

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/08/2024

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Directions to “HEALTHTEXAS PROVIDER NETWORK ” Practice Location

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