Provider Demographics
NPI:1073779500
Name:TEJAS HEALTH CARE
Entity Type:Organization
Organization Name:TEJAS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-968-2000
Mailing Address - Street 1:753 E TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2353
Mailing Address - Country:US
Mailing Address - Phone:979-968-2000
Mailing Address - Fax:979-968-2001
Practice Address - Street 1:890 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2364
Practice Address - Country:US
Practice Address - Phone:979-968-2000
Practice Address - Fax:979-968-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202580110Medicaid
TX202580107Medicaid
TX202580104Medicaid