Organization
HEALTHTEXAS PROVIDER NETWORK-TRANSPLANT SERVICES LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-4650
(817) 922-4655
Mailing address
8080 N CENTRAL EXPY, SUITE 600, LB82, DALLAS, TX 75206-1838
(972) 860-8648
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
00732U
TX
208600000X
Surgery Physician
00732U
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078JQ
BCBSTX
TX
05
—
159147101
—
TX
Enumeration date
07/06/2005
Last updated
05/05/2010
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