Provider Demographics
NPI:1568529477
Name:FOUNDATIONS OF TEXOMA ENTERPRISES, PA
Entity Type:Organization
Organization Name:FOUNDATIONS OF TEXOMA ENTERPRISES, PA
Other - Org Name:FOUNDATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-322-6981
Mailing Address - Street 1:1411 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4302
Mailing Address - Country:US
Mailing Address - Phone:940-322-6981
Mailing Address - Fax:940-322-1907
Practice Address - Street 1:1411 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4302
Practice Address - Country:US
Practice Address - Phone:940-322-6981
Practice Address - Fax:940-322-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL59752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z321Medicare PIN