Active NPI
Healthtexas Provider Network
- Cardiovascular Disease Physician
- Shreveport, LA
National Provider Identifier
1871214254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- Legal business name
- HEALTHTEXAS PROVIDER NETWORK
- Practice address
- 1453 E Bert Kouns Industrial Loop Ste 212
Shreveport, LA 71105-6810 - Phone
- (214) 820-6856
- NPI assigned
- Sep 6, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michelle J Telford
- Title
- Managed Care Consultant
- Phone
- (469) 800-8648
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | Primary |
Addresses
Primary practice location
1453 E Bert Kouns Industrial Loop Ste 212
Shreveport, LA 71105-6810
Mailing address
301 N Washington Ave
Dallas, TX 75246-1754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221026000113 | LA | Part B Supplier - Clinic/Group Practice | 1355254210 |
Receives reassigned benefits from 1 practitioner Practice locations: Shreveport, LA |
National Provider Directory
National Provider Directory- Tax ID family
- BSW Advanced Heart Failure
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662422400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1662422400000",
"number": "1871214254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N WASHINGTON AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752461754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1453 E BERT KOUNS INDUSTRIAL LOOP STE 212",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711056810",
"telephone_number": "214-820-6856"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEALTHTEXAS PROVIDER NETWORK",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-06",
"last_updated": "2022-09-06",
"certification_date": "2022-09-06",
"status": "A",
"authorized_official_last_name": "TELFORD",
"authorized_official_first_name": "MICHELLE",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "MANAGED CARE CONSULTANT",
"authorized_official_telephone_number": "469-800-8648"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.