Provider Demographics
NPI:1083858831
Name:TEXARKANA REGIONAL HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:TEXARKANA REGIONAL HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-1072
Mailing Address - Street 1:PO BOX 847045
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7045
Mailing Address - Country:US
Mailing Address - Phone:866-724-6662
Mailing Address - Fax:314-432-9386
Practice Address - Street 1:1000 PINE ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5100
Practice Address - Country:US
Practice Address - Phone:903-798-7317
Practice Address - Fax:903-798-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196542002Medicaid
TX207889101Medicaid
TX207889101Medicaid
AR249390Medicare PIN
TX0A5300Medicare PIN