Provider Demographics
NPI:1083398457
Name:TEXAS INDEPENDENCE HEALTH PLAN INC.
Entity Type:Organization
Organization Name:TEXAS INDEPENDENCE HEALTH PLAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0694
Mailing Address - Street 1:1908 N LAURENT ST STE 250
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5417
Mailing Address - Country:US
Mailing Address - Phone:361-576-0694
Mailing Address - Fax:
Practice Address - Street 1:1908 N LAURENT ST STE 250
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5417
Practice Address - Country:US
Practice Address - Phone:361-576-0694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization