Basic Information
| Provider Information | |||||||||
| NPI: | 1235154824 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH SERVICES OF NORTH TEXAS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 N INTERSTATE 35 UNIT 312 | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762073318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403811501 | ||||||||
| FaxNumber: | 9405668059 | ||||||||
| Practice Location | |||||||||
| Address1: | 4304 MESA DR | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403811501 | ||||||||
| FaxNumber: | 9405917830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | CONTRERAS | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
| AuthorizedOfficialMiddleName: | NAVARRO | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9404359044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 157438601 | 05 | TX | MEDICAID |