Provider Demographics
NPI:1255911590
Name:NWTX PHYSICIAN NETWORK, PLLC
Entity type:Organization
Organization Name:NWTX PHYSICIAN NETWORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP - PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-382-4943
Mailing Address - Street 1:PO BOX 844798 ATT: IPM CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4798
Mailing Address - Country:US
Mailing Address - Phone:484-913-7434
Mailing Address - Fax:
Practice Address - Street 1:104 N BRYAN ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4010
Practice Address - Country:US
Practice Address - Phone:806-274-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health