Provider Demographics
NPI: | 1558521179 |
---|---|
Name: | TEXAS SPECIALTY PHYSICIANS |
Entity Type: | Organization |
Organization Name: | TEXAS SPECIALTY PHYSICIANS |
Other - Org Name: | PARKVIEW SPECIALTY CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT, CORPORATE SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KATHY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TEAGUE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 629-253-5121 |
Mailing Address - Street 1: | 4002 S LOOP 256 STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | PALESTINE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75801-8492 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 037-315-4429 |
Mailing Address - Fax: | 903-723-3325 |
Practice Address - Street 1: | 4002 S LOOP 256 |
Practice Address - Street 2: | |
Practice Address - City: | PALESTINE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75801-8491 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-731-5030 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-17 |
Last Update Date: | 2024-01-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103TC0700X, 207Q00000X, 207R00000X, 207RC0000X, 207RP1001X, 207V00000X, 207X00000X, 208000000X, 2084P0800X, 208800000X, 363A00000X, 363LP0808X, 363LW0102X, 367A00000X | ||
TX | G5232 | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |