Provider Demographics
NPI:1730117219
Name:TEXOMA INTERSTATE VENTURES
Entity Type:Organization
Organization Name:TEXOMA INTERSTATE VENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:MACKEY
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-416-4126
Mailing Address - Street 1:1000 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2035
Mailing Address - Country:US
Mailing Address - Phone:903-416-5144
Mailing Address - Fax:903-416-4137
Practice Address - Street 1:3126 W FM 120
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-416-7544
Practice Address - Fax:903-416-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00846RMedicare ID - Type Unspecified