Basic Information
| Provider Information | |||||||||
| NPI: | 1285805473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PH DENTON PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8440 WALNUT HILL LN | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752313833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143455756 | ||||||||
| FaxNumber: | 2143451452 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 N INTERSTATE 35 | ||||||||
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| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762015119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9408987000 | ||||||||
| FaxNumber: | 9403233400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 05/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | MORTON | ||||||||
| AuthorizedOfficialFirstName: | STAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9408987003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 195355601 | 05 | TX | MEDICAID |