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	207R00000X	Internal Medicine Physician	00T04Z	TX
2	207RG0100X	Gastroenterology Physician	00T04Z	TX
3	207RI0008X	Hepatology Physician	00T04Z	TX
4	207RR0500X	Rheumatology Physician	00T04Z	TX
5	2084N0400X	Neurology Physician	00T04Z	TX
6	208600000X	Surgery Physician	00T04Z	TX
7	208800000X	Urology Physician	00T04Z	TX
8	207Q00000X	Family Medicine Physician	00T04Z	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00T04Z	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235135906
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	:	972-860-8679

Provider Business Practice Location Address
First Line	:	5232 COLLEYVILLE BLVD
Second Line	:	SUITE 100
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-7826
Country	:	US
Telephone Number	:	817-498-9920
Fax Number	:	817-498-0635

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	01/06/2025

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Directions to “HEALTHTEXAS PROVIDER NETWORK ” Practice Location

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