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Contact Information

HEALTHPORT P.A.
4295 KINSEY DR
TYLER, TX75703-1004
 Phone: 903-526-5000
 Fax: 903-526-5006
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

2081P2900X 25 Physician/Physical Medicine and Rehabilitation
 

Chiropractor

111N00000X 35 Chiropractic
 

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for HEALTHPORT P.A.

NPI Number 1154577641
LBN Legal business name HEALTHPORT P.A.
Authorized official KENNETH FULTS - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 08/15/2008
Last updated 01/07/2013 - About 13 years ago
Identifiers
TX Medicaid 208679501
TX Other 0066SG BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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