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	207N00000X	Dermatology Physician	00N85X	TX
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	00N85X	TX
3	207R00000X	Internal Medicine Physician	00N85X	TX
4	207RC0000X	Cardiovascular Disease Physician	00N85X	TX
5	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	00N85X	TX
6	207RG0100X	Gastroenterology Physician	00N85X	TX
7	207RI0008X	Hepatology Physician	00N85X	TX
8	207RR0500X	Rheumatology Physician	00N85X	TX
9	207V00000X	Obstetrics & Gynecology Physician	00N85X	TX
10	208000000X	Pediatrics Physician	00N85X	TX
11	208100000X	Physical Medicine & Rehabilitation Physician	00N85X	TX
12	2084N0400X	Neurology Physician	00N85X	TX
13	208600000X	Surgery Physician	00N85X	TX
14	208M00000X	Hospitalist Physician	00N85X	TX
15	207Q00000X	Family Medicine Physician	00N85X	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00N85X	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760488936
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	:	3600 GASTON AVE
Second Line	:	STE 656
City	:	DALLAS
State	:	TX
Zip	:	75246-1906
Country	:	US
Telephone Number	:	214-820-3466
Fax Number	:	214-820-3468

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/06/2025

Similar Medicare Providers

1508418427 — KRISTEN MARIE STANSBURY FNP-C
Practice Location Address:

3600 GASTON AVE STE 656
DALLAS, TX
75246-1906

Practice Phone: 214-820-3466
Practice Fax:

1134861370 — SOONGJIN AHN DO
Practice Location Address:

3600 GASTON AVE STE 651
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75246-1906

Practice Phone: 214-820-3275
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1184366080 — LESLIE HAVEMANN, MD, PLLC
Practice Location Address:

3600 GASTON AVE STE 651
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75246-1906

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Practice Fax:

1508837113 — DR. EDNA TOUBES-KLINGLER MD
Practice Location Address:

1906 PEABODY AVE
DALLAS, TX
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Practice Phone: 214-421-7848
Practice Fax: 214-421-1119

1205978368 — DR. MARSDEN KEITH RAWLINGS MD
Practice Location Address:

1906 PEABODY AVE
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75215-2821

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1982749123 — MS. EJEANEE D. QUEEN RN, FNP
Practice Location Address:

1906 PEABODY AVE
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Directions to “HEALTHTEXAS PROVIDER NETWORK ” Practice Location

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