Organization
HEALTHTEXAS PROVIDER NETWORK
Active
Other names
Physiatric Medicine Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
1643 LANCASTER DR, SUITE 101A, GRAPEVINE, TX 76051-3593
(817) 424-4151
(817) 424-4181
Mailing address
8080 N CENTRAL EXPY, SUITE 1650, DALLAS, TX 75206-1838
(972) 860-8648
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T89Z
BCBS
TX
Enumeration date
07/11/2006
Last updated
03/07/2008
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