MEDICARE: HEALTHTEXAS PROVIDER NETWORK - CARDIO-THORACIC SERVICES 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	00872U	TX

General Provider Information

NPI Number	:	1871598466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHTEXAS PROVIDER NETWORK - CARDIO-THORACIC SERVICES LLP

Provider Business Mailing Address
First Line	:	8080 N CENTRAL EXPY, LB 82
Second Line	:	STE 1650
City	:	DALLAS
State	:	TX
Zip	:	75206-3789
Country	:	US
Telephone Number	:	972-860-8653
Fax Number	:	972-860-8679

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	STE 404
City	:	DALLAS
State	:	TX
Zip	:	75246-1804
Country	:	US
Telephone Number	:	214-827-3890
Fax Number	:	214-823-9310

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	:	02/23/2008

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