Provider Demographics
NPI:1992920375
Name:HEALTH TEXAS PROVIDER NETWORK
Entity type:Organization
Organization Name:HEALTH TEXAS PROVIDER NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-800-3524
Mailing Address - Street 1:PO BOX 844128
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4128
Mailing Address - Country:US
Mailing Address - Phone:469-800-3524
Mailing Address - Fax:469-800-3564
Practice Address - Street 1:734 E QUINLAN PKWY
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-8640
Practice Address - Country:US
Practice Address - Phone:469-800-3640
Practice Address - Fax:469-800-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137940601Medicaid
TX017949101Medicaid
TX137940610Medicaid
TX005EEOtherBCBS GROUP
TXCP0098OtherRAILROAD MEDICARE
TX005EEOtherBCBS GROUP
TX00J629Medicare PIN