Provider Demographics
NPI:1770536518
Name:TEXOMACARE
Entity type:Organization
Organization Name:TEXOMACARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:5012 US HWY 75 S, STE 300
Mailing Address - Street 2:ATT. BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 N HWY 121
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2345
Practice Address - Country:US
Practice Address - Phone:903-583-3111
Practice Address - Fax:903-583-1444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXOMACARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127350002Medicaid
TX127350002Medicaid