Organization
TEXOMACARE
Active
Parent organization
TEXOMACARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
TEXOMACARE
Authorized official
TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
500 BROOKSIDE DR, MADILL, OK 73446-3643
(580) 795-5506
(580) 795-5145
Mailing address
5012 US HWY 75 S, SUITE 300, ATT: BILLING, DENISON, TX 75020
(903) 416-1726
(903) 416-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100754740A
—
OK
01
—
CH3977
RR MEDICARE
OK
Enumeration date
05/20/2006
Last updated
06/28/2019
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