Provider Demographics
NPI:1558684944
Name:PHYNET, INC
Entity type:Organization
Organization Name:PHYNET, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-247-0484
Mailing Address - Street 1:123 N MAIN ST
Mailing Address - Street 2:PO BOX 252
Mailing Address - City:LONE STAR
Mailing Address - State:TX
Mailing Address - Zip Code:75668-0252
Mailing Address - Country:US
Mailing Address - Phone:903-656-0633
Mailing Address - Fax:903-656-0638
Practice Address - Street 1:4002 TECHNOLOGY CTR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2697
Practice Address - Country:US
Practice Address - Phone:903-247-0484
Practice Address - Fax:903-247-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center