NPIMap

Organization Active NPI

Healthtexas Provider Network

  • Internal Medicine Physician
  • Waxahachie, TX
National Provider Identifier
1629074893
Registry record updated Feb 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
00T26W Issued in TX
Legal business name
HEALTHTEXAS PROVIDER NETWORK
Practice address
505 N Highway 77
Ste 200
Waxahachie, TX 75165-1129
Phone
(972) 923-1686
Fax
(972) 923-9268
NPI assigned
Jun 22, 2005
Last updated
Feb 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2008

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 Physician 207Q00000X 00T26W TX
Internal Medicine Physician 207R00000X 00T26W TX Primary
Pediatrics Physician 208000000X 00T26W TX

Addresses

Primary practice location

505 N Highway 77
Ste 200
Waxahachie, TX 75165-1129

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00T26WOtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040727001187 TX Part B Supplier - Clinic/Group Practice 1355254210 Receives reassigned benefits from 3,506 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

505 N Highway 77
Ste 200
Waxahachie, TX 75165
Phone (972) 923-1686

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203292800000",
    "number": "1629074893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 N CENTRAL EXPRESSWAY, 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": "505 N HIGHWAY 77",
            "address_2": "STE 200",
            "city": "WAXAHACHIE",
            "state": "TX",
            "postal_code": "751651129",
            "telephone_number": "972-923-1686",
            "fax_number": "972-923-9268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHTEXAS PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-02-18",
        "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": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "00T26W",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "00T26W",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "00T26W",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00T26W",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxahachie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.