Provider Demographics
NPI:1811151525
Name:VERNON J HAYES,D.O.,P.A.
Entity type:Organization
Organization Name:VERNON J HAYES,D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-731-3936
Mailing Address - Street 1:2600 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4525
Mailing Address - Country:US
Mailing Address - Phone:817-731-3936
Mailing Address - Fax:817-782-0206
Practice Address - Street 1:2600 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4525
Practice Address - Country:US
Practice Address - Phone:817-731-3936
Practice Address - Fax:817-782-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1050662TOtherCOVENTRY HEALTH
TX1155103 01Medicaid
TX81X170OtherBLUE CROSS BLUE SHILED
TX0096QROtherBLUE CROSS BLUE SHIELD
TX10028507OtherAMERIGROUP/TEXAS MEDICAID