Provider Demographics
NPI:1508051202
Name:PLEXUS TREATMENT CENTERS, P.A.
Entity Type:Organization
Organization Name:PLEXUS TREATMENT CENTERS, P.A.
Other - Org Name:PLEXUS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:DEVIN
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-442-4878
Mailing Address - Street 1:1510 STATE HIGHWAY 206
Mailing Address - Street 2:
Mailing Address - City:CISCO
Mailing Address - State:TX
Mailing Address - Zip Code:76437-6450
Mailing Address - Country:US
Mailing Address - Phone:254-442-4878
Mailing Address - Fax:254-442-3754
Practice Address - Street 1:1510 STATE HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:CISCO
Practice Address - State:TX
Practice Address - Zip Code:76437-6450
Practice Address - Country:US
Practice Address - Phone:254-442-4878
Practice Address - Fax:254-442-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X, 208D00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y444Medicare PIN