Provider Demographics
NPI:1548226533
Name:MEDICAL SPECIALISTS OF TEXAKRANA
Entity type:Organization
Organization Name:MEDICAL SPECIALISTS OF TEXAKRANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FEUTRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-794-3701
Mailing Address - Street 1:1002 TEXAS BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5107
Mailing Address - Country:US
Mailing Address - Phone:903-794-3701
Mailing Address - Fax:903-794-3518
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-794-3701
Practice Address - Fax:903-794-3518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SPECIALISTS OF TEXAKRANA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427056894OtherNPI
TX1194722173OtherNPI
TX1336147701OtherNPI