Provider Demographics
NPI:1063630937
Name:HEALTH TEXAS PROVIDER NETWORK
Entity Type:Organization
Organization Name:HEALTH TEXAS PROVIDER NETWORK
Other - Org Name:PCA ROYSE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-800-3670
Mailing Address - Street 1:PO BOX 844128
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2148
Mailing Address - Country:US
Mailing Address - Phone:469-800-3524
Mailing Address - Fax:469-800-3564
Practice Address - Street 1:6257 FM 2642 BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3223
Practice Address - Country:US
Practice Address - Phone:469-800-3670
Practice Address - Fax:469-800-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137940601Medicaid
TX091888002Medicaid
TX8G4495OtherBCBS PROVIDER #
TX00J629Medicare PIN