Organization
HEALTHTEXAS PROVIDER NETWORK - NEUROSURGICAL ASSOCIATES, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN E. FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
1420 8TH AVE, SUITE 104, FORT WORTH, TX 76104-4138
(817) 920-0003
(817) 920-0068
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
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0079LW
BCBS
TX
05
—
1876500-01
—
TX
Enumeration date
08/29/2006
Last updated
05/05/2009
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