Organization
HEALTHTEXAS PROVIDER NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
505 N HIGHWAY 77, STE 200, WAXAHACHIE, TX 75165-1129
(972) 923-1686
(972) 923-9268
Mailing address
8080 N CENTRAL EXPRESSWAY, LB 82, STE 1650, DALLAS, TX 75206
(972) 860-8648
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
00T26W
TX
207R00000X
Internal Medicine Physician
Primary
00T26W
TX
208000000X
Pediatrics Physician
00T26W
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T26W
BCBS
TX
Enumeration date
06/22/2005
Last updated
02/18/2008
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