Provider Demographics
| NPI: | 1770122566 |
|---|---|
| Name: | TEXAS PHYSICIAN NETWORK PLLC |
| Entity type: | Organization |
| Organization Name: | TEXAS PHYSICIAN NETWORK PLLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | EDGAR |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CHANG |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | DC |
| Authorized Official - Phone: | 310-993-2225 |
| Mailing Address - Street 1: | 190 E STACY RD STE 306-382 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ALLEN |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 75002-8734 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 972-876-8242 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 13480 VETERANS MEMORIAL DR STE R3 |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77014-1670 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 972-876-8242 |
| Practice Address - Fax: | 281-666-8299 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-12-27 |
| Last Update Date: | 2020-03-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 261QE0700X | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| No | 261QR1100X | Ambulatory Health Care Facilities | Clinic/Center | Research |
| No | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| No | 335V00000X | Suppliers | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
