Provider Demographics
NPI:1427054402
Name:HEALTHTEXAS PROVIDER NETWORK
Entity type:Organization
Organization Name:HEALTHTEXAS PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-865-2753
Mailing Address - Street 1:301 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1754
Mailing Address - Country:US
Mailing Address - Phone:469-800-8742
Mailing Address - Fax:972-860-8679
Practice Address - Street 1:1110 PARKER SQ
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7432
Practice Address - Country:US
Practice Address - Phone:972-724-1707
Practice Address - Fax:972-724-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00U07B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0855389-01Medicaid
TX00U07BMedicare PIN
TXCD6866Medicare PIN