Provider Demographics
NPI:1184841298
Name:BESSIE OWENS D.O. ,P.A.
Entity Type:Organization
Organization Name:BESSIE OWENS D.O. ,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-526-7900
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-1600
Mailing Address - Country:US
Mailing Address - Phone:972-526-7900
Mailing Address - Fax:972-526-7906
Practice Address - Street 1:9500 LAKEVIEW PKWY # 300
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4557
Practice Address - Country:US
Practice Address - Phone:972-526-7900
Practice Address - Fax:972-526-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO8224B01Medicaid
TXF69532Medicare UPIN
TXPO8224B01Medicaid