Provider Demographics
NPI:1073568127
Name:CROSS TIMBERS ENT PLLC
Entity Type:Organization
Organization Name:CROSS TIMBERS ENT PLLC
Other - Org Name:CROSS TIMBERS EAR, NOSE & THROAT, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONANT
Authorized Official - Suffix:
Authorized Official - Credentials:COPM
Authorized Official - Phone:817-261-3000
Mailing Address - Street 1:400 WEST ARBROOK BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3174
Mailing Address - Country:US
Mailing Address - Phone:817-261-3000
Mailing Address - Fax:817-274-4292
Practice Address - Street 1:400 WEST ARBROOK B;LVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3174
Practice Address - Country:US
Practice Address - Phone:817-261-3000
Practice Address - Fax:817-274-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080303301Medicaid
TX080303301Medicaid