Provider Demographics
NPI:1992932032
Name:TEXAS SPECIALTY PHYSICIANS
Entity type:Organization
Organization Name:TEXAS SPECIALTY PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-867-7900
Mailing Address - Street 1:514 S BONHAM ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3600
Mailing Address - Country:US
Mailing Address - Phone:254-562-5961
Mailing Address - Fax:254-562-2813
Practice Address - Street 1:2203 W LAMPASAS ST
Practice Address - Street 2:SUITE 211
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5644
Practice Address - Country:US
Practice Address - Phone:972-875-3997
Practice Address - Fax:972-875-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3177Medicare PIN