Provider Demographics
NPI:1689899916
Name:HEALTH TEXAS PROVIDER NETWORK
Entity Type:Organization
Organization Name:HEALTH TEXAS PROVIDER NETWORK
Other - Org Name:PCA ELLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-800-3524
Mailing Address - Street 1:PO BOX 844128
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4128
Mailing Address - Country:US
Mailing Address - Phone:469-800-3524
Mailing Address - Fax:469-800-3564
Practice Address - Street 1:4803 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-454-2246
Practice Address - Fax:903-450-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137940608Medicaid
TXP00134601OtherRAILROAD MEDICARE
TX007EEOtherBCBS GROUP
TXP00134601OtherRAILROAD MEDICARE
TX453871Medicare Oscar/Certification