Provider Demographics
NPI:1477735140
Name:NANETTE V EVANS M.D., P.A.
Entity Type:Organization
Organization Name:NANETTE V EVANS M.D., P.A.
Other - Org Name:CROSS TIMBERS RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-965-2663
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401
Mailing Address - Country:US
Mailing Address - Phone:254-965-9729
Mailing Address - Fax:254-968-7979
Practice Address - Street 1:150 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1860
Practice Address - Country:US
Practice Address - Phone:254-965-9729
Practice Address - Fax:254-968-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0970352-01Medicaid
TX196958601Medicaid
TX0062QQOtherBCBS
DO0818OtherRAILROAD PTAN
TX196958601Medicaid