Organization
HEALTHTEXAS PROVIDER NETWORK - PHYSIATRIC MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
507 N HIGHWAY 77, STE 700, WAXAHACHIE, TX 75165-1889
(972) 923-2738
(972) 935-9230
Mailing address
8080 N CENTRAL EXPY, LB 82, STE 1650, DALLAS, TX 75206-3789
(972) 860-8653
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0016AH
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T89Z
BCBS
TX
Enumeration date
06/20/2005
Last updated
03/07/2008
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