Organization
HEALTHTEXAS PROVIDER NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN E FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
900 W MAGNOLIA AVE, SUITE 201, FT WORTH, TX 76104-8517
(817) 921-6166
(817) 921-9594
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
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077DJ
BCBS
TX
05
—
200663701
—
TX
Enumeration date
10/24/2008
Last updated
04/20/2010
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