Provider Demographics
NPI:1073621074
Name:TEAM PHYSICIANS OF TEXAS PA
Entity Type:Organization
Organization Name:TEAM PHYSICIANS OF TEXAS PA
Other - Org Name:VAL VERDE RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-691-2848
Mailing Address - Street 1:234 MORRELL RD STE 362
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5876
Mailing Address - Country:US
Mailing Address - Phone:865-691-2848
Mailing Address - Fax:865-531-3079
Practice Address - Street 1:801 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4112
Practice Address - Country:US
Practice Address - Phone:865-691-2848
Practice Address - Fax:865-531-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L25GOtherBC BS TEXAS
TXCE7711OtherPALMETTO RAILROAD MEDICAR
TX083679301Medicaid
TX00L25GMedicare PIN