Provider Demographics
NPI:1790723468
Name:HEALTHTEXAS PROVIDER NETWORK
Entity Type:Organization
Organization Name:HEALTHTEXAS PROVIDER NETWORK
Other - Org Name:PCA GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-800-8500
Mailing Address - Street 1:8080 N CENTRAL EXPY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3794
Mailing Address - Country:US
Mailing Address - Phone:469-800-8649
Mailing Address - Fax:
Practice Address - Street 1:4400 IH 30 W
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-4620
Practice Address - Country:US
Practice Address - Phone:469-800-3524
Practice Address - Fax:469-800-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J629OtherBCBS GROUP
TX137940607Medicaid
TX091888002Medicaid
TX137940601Medicaid
TX091888002Medicaid
TX453870Medicare Oscar/Certification
TX00J629OtherBCBS GROUP