Provider Demographics
NPI:1205860517
Name:HEALTHTEXAS PROVIDER NETWORK - NEUROSURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:HEALTHTEXAS PROVIDER NETWORK - NEUROSURGICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FOURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-860-8649
Mailing Address - Street 1:8080 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1838
Mailing Address - Country:US
Mailing Address - Phone:972-860-8648
Mailing Address - Fax:972-860-8679
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2222
Practice Address - Country:US
Practice Address - Phone:214-820-8585
Practice Address - Fax:214-820-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079LWOtherBCBS
TX00554XMedicare ID - Type Unspecified