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
(214) 827-3890
(214) 823-9310
Mailing address
8080 N CENTRAL EXPY, STE 1650, DALLAS, TX 75206-3789
(972) 860-8653
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
00586X
TX
Other
Enumeration date
06/23/2005
Last updated
08/22/2020
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