NPIMap

Organization Active NPI

Healthtexas Provider Network

  • Family Medicine Physician
  • Grand Prairie, TX
National Provider Identifier
1528063146
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0079BV Issued in TX
Legal business name
HEALTHTEXAS PROVIDER NETWORK
Practice address
2740 N Hwy 360
Suite 100
Grand Prairie, TX 75050-6401
Phone
(972) 606-8300
Fax
(972) 606-4940
NPI assigned
Jun 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ellen Elizabeth Fourton
Title
Director
Phone
(972) 860-8649

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 0079BV TX Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 0079BV TX
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 0079BV TX

Addresses

Primary practice location

2740 N Hwy 360
Suite 100
Grand Prairie, TX 75050-6401

Mailing address

8080 N Central Expy, LB 82
Ste 1650
Dallas, TX 75206
Phone (972) 860-8648

Other identifiers 2

IdentifierTypeStateIssuer
0811697-02MedicaidTX
0079BVOtherTXBCBSTX

National Provider Directory

National Provider Directory

Locations

2210 N State Highway 360
Grand Prairie, TX 75050
Phone (972) 606-8300

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1528063146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 N CENTRAL EXPY, LB 82",
            "address_2": "STE 1650",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75206",
            "telephone_number": "972-860-8648",
            "fax_number": "972-860-8679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 N HWY 360",
            "address_2": "SUITE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750506401",
            "telephone_number": "972-606-8300",
            "fax_number": "972-606-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHTEXAS PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "FOURTON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "972-860-8649",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "0079BV",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "0079BV",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "0079BV",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0811697-02",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "0079BV",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.