Provider Demographics
NPI:1093006389
Name:AMERITEX HOUSECALLS, P.A.
Entity Type:Organization
Organization Name:AMERITEX HOUSECALLS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GALLENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-949-0130
Mailing Address - Street 1:10440 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 251
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4608
Mailing Address - Country:US
Mailing Address - Phone:214-272-8192
Mailing Address - Fax:214-484-4839
Practice Address - Street 1:10440 E NORTHWEST HWY
Practice Address - Street 2:SUITE 251
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4608
Practice Address - Country:US
Practice Address - Phone:214-272-8192
Practice Address - Fax:214-484-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
TX1513213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty