MEDICARE: PHYSICIANS NETWORK ASSOCIATION

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	302R00000X	Health Maintenance Organization	302R00000X	TX

General Provider Information

NPI Number	:	1568613438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS NETWORK ASSOCIATION

Provider Business Mailing Address
First Line	:	1622 MAC DAVIS LN
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79401-2625
Country	:	US
Telephone Number	:	806-799-1326
Fax Number	:	806-795-1294

Provider Business Practice Location Address
First Line	:	1511 PRESTON ST
Second Line	:	STISF: MEDICAL DEPARTMENT
City	:	HOUSTON
State	:	TX
Zip	:	77002-2131
Country	:	US
Telephone Number	:	713-223-0601
Fax Number	:	713-223-9519

Authorized Official
Title or Position	:	REGIONAL DIRECTOR
Name	:	MRS. LARNYA WALKER
Credential	:	RN
Telephone Number	:	832-654-0055

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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Directions to “PHYSICIANS NETWORK ASSOCIATION ” Practice Location

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