Provider Demographics
NPI:1881064731
Name:TEXARKANA GROUP, P.L.L.C
Entity type:Organization
Organization Name:TEXARKANA GROUP, P.L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-612-3677
Mailing Address - Street 1:2100 N. STATE LINE AVE.
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:870-779-1111
Mailing Address - Fax:870-779-1115
Practice Address - Street 1:2100 N. STATE LINE AVE.
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854
Practice Address - Country:US
Practice Address - Phone:870-779-1111
Practice Address - Fax:870-779-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty