Provider Demographics
NPI:1821246182
Name:HEMORRHOID CARE CLINIC OF TEXAS
Entity Type:Organization
Organization Name:HEMORRHOID CARE CLINIC OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-294-7444
Mailing Address - Street 1:PO BOX 2626
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2626
Mailing Address - Country:US
Mailing Address - Phone:817-294-7444
Mailing Address - Fax:
Practice Address - Street 1:4230 LBJ FWY
Practice Address - Street 2:SUITE 308
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5806
Practice Address - Country:US
Practice Address - Phone:866-994-2289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004MPOtherBCBSTX
TX174681001Medicaid
TX0004MPOtherBCBSTX