Provider Demographics
NPI:1710108923
Name:TEXAS NATIVE HEALTH
Entity Type:Organization
Organization Name:TEXAS NATIVE HEALTH
Other - Org Name:URBAN INTER-TRIBAL CENTER OF TEXAS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OMER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-941-1050
Mailing Address - Street 1:1283 RECORD CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6001
Mailing Address - Country:US
Mailing Address - Phone:214-941-1050
Mailing Address - Fax:214-946-4738
Practice Address - Street 1:1283 RECORD CROSSING RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6001
Practice Address - Country:US
Practice Address - Phone:214-941-1050
Practice Address - Fax:214-946-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02052261QF0400X
TX12584332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311491001Medicaid
451914Medicare PIN
2144123OtherPK