Provider Demographics
NPI:1487747937
Name:TEXAS MANAGED INC.
Entity type:Organization
Organization Name:TEXAS MANAGED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-477-7490
Mailing Address - Street 1:10906 FM 1960 W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:281-477-7490
Mailing Address - Fax:281-477-3128
Practice Address - Street 1:10906 FM 1960 W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-477-7490
Practice Address - Fax:281-477-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610925Medicare ID - Type Unspecified
TXC19746Medicare UPIN