Organization
HEALTHTEXAS PROVIDER NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE J TELFORD (MANAGED CARE CONSULTANT)
(214) 865-2774
Entity
Organization
Contact information
Practice address
4 SE AVE A, IDABEL, OK 74745-4620
(580) 208-2700
Mailing address
301 N WASHINGTON AVE, DALLAS, TX 75246-1754
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6J9280
GROUP PTAN
OK
Enumeration date
10/11/2023
Last updated
04/23/2024
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