Provider Demographics
NPI:1386689255
Name:REPUBLIC HOSPITALISTS SERVICES PLLC
Entity Type:Organization
Organization Name:REPUBLIC HOSPITALISTS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-870-4609
Mailing Address - Street 1:PO BOX 8845
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-0845
Mailing Address - Country:US
Mailing Address - Phone:817-451-4208
Mailing Address - Fax:
Practice Address - Street 1:500 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7354
Practice Address - Country:US
Practice Address - Phone:903-870-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051MYOtherBLUE CROSS BLUE SHIELD
OK200080500AMedicaid
TX177702101Medicaid
TX0051MYOtherBLUE CROSS BLUE SHIELD
TXDD9504Medicare PIN