Provider Demographics
NPI:1962545541
Name:TEXARKANA FAMILY PRACTICE, P.A.
Entity type:Organization
Organization Name:TEXARKANA FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SARNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-794-0515
Mailing Address - Street 1:1408 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3534
Mailing Address - Country:US
Mailing Address - Phone:903-794-0515
Mailing Address - Fax:903-793-8000
Practice Address - Street 1:1408 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3534
Practice Address - Country:US
Practice Address - Phone:903-794-0515
Practice Address - Fax:903-793-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125890001Medicaid
TXP03228OtherNOVASYS
TX168270000-00OtherQUALCHOICE
TX117004502Medicaid
TX5J245OtherARKANSAS BLUE CROSS BLUE SHIELD
TX86Z860OtherTEXAS BLUE CROSS BLUE SHIELD
TX080089119OtherRAILROAD MEDICARE
TX86Z860Medicare PIN
TX080089119OtherRAILROAD MEDICARE