# HEALTHTEXAS PROVIDER NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295176378
- **Authorized official:** ELLEN FOURTON (VICE PRESIDENT)
- **Authorized official phone:** (972) 860-8649

## Contact information

- **Practice address:** 4501 SWISS AVE, DALLAS, TX 75204-7119
- **Practice address phone:** (214) 820-8700
- **Practice address fax:** (214) 820-8707
- **Mailing address:** 4501 SWISS AVE, DALLAS, TX 75204-7119
- **Mailing address phone:** (214) 820-8700
- **Mailing address fax:** (214) 820-8707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 07/17/2013
- **Last updated:** 09/17/2019