Provider Demographics
NPI:1891886982
Name:TEXAS MEDICAL NETWORK LLC
Entity Type:Organization
Organization Name:TEXAS MEDICAL NETWORK LLC
Other - Org Name:WILLIAM D LITTLEJOHN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-244-8555
Mailing Address - Street 1:2629 S CHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-3919
Mailing Address - Country:US
Mailing Address - Phone:817-244-8555
Mailing Address - Fax:817-244-8666
Practice Address - Street 1:2629 S CHERRY LANE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3919
Practice Address - Country:US
Practice Address - Phone:817-244-8555
Practice Address - Fax:817-244-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX856310OtherBCBS
C18473Medicare UPIN
TX856310OtherBCBS