Basic Information
| Provider Information | |||||||||
| NPI: | 1528478120 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH SERVICES OF NORTH TEXAS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 N INTERSTATE 35 | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762073432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403811501 | ||||||||
| FaxNumber: | 9405668059 | ||||||||
| Practice Location | |||||||||
| Address1: | 3537 S I-35 E | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403811501 | ||||||||
| FaxNumber: | 9405917830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| 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 | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 337190801 | 05 | TX | MEDICAID |