Provider Demographics
NPI:1568613438
Name:PHYSICIANS NETWORK ASSOCIATION
Entity Type:Organization
Organization Name:PHYSICIANS NETWORK ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-654-0055
Mailing Address - Street 1:1622 MAC DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2625
Mailing Address - Country:US
Mailing Address - Phone:806-799-1326
Mailing Address - Fax:806-795-1294
Practice Address - Street 1:1511 PRESTON ST
Practice Address - Street 2:STISF: MEDICAL DEPARTMENT
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-2131
Practice Address - Country:US
Practice Address - Phone:713-223-0601
Practice Address - Fax:713-223-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization