MEDICARE: HEALTHTEXAS PROVIDER NETWORK-NEUROSURGICAL ASSOCIATES, LLP

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	2085R0001X	Radiation Oncology Physician	00554X	TX
2	207T00000X	Neurological Surgery Physician	00554X	TX

General Provider Information

NPI Number	:	1437154077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHTEXAS PROVIDER NETWORK-NEUROSURGICAL ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	8080 N CENTRAL EXPY, LB 82
Second Line	:	STE 1650
City	:	DALLAS
State	:	TX
Zip	:	75206
Country	:	US
Telephone Number	:	972-860-8648
Fax Number	:	972-860-8679

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	STE 1158-WADLEY
City	:	DALLAS
State	:	TX
Zip	:	75246
Country	:	US
Telephone Number	:	214-820-8585
Fax Number	:	214-820-8590

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ELLEN ELIZABETH FOURTON
Credential	:
Telephone Number	:	972-860-8649

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/27/2007

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