Provider Demographics
NPI:1346203528
Name:HEALTHTEXAS PROVIDER NETWORK
Entity Type:Organization
Organization Name:HEALTHTEXAS PROVIDER NETWORK
Other - Org Name:BAYLOR AMBULATORY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-758-4953
Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5337
Mailing Address - Country:US
Mailing Address - Phone:972-758-4950
Mailing Address - Fax:972-758-4955
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5337
Practice Address - Country:US
Practice Address - Phone:972-758-4950
Practice Address - Fax:972-758-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008136261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172266201Medicaid
TXHH035AOtherBCBS PROVIDER
TX008136OtherTEXAS DEPARTMENT OF STATE
TX67394OtherAAAHC
TXY29426Medicare UPIN
TXHH035AOtherBCBS PROVIDER
TX172266201Medicaid