Provider Demographics
NPI:1366183543
Name:TEXAS INDEPENDENT FIRST ASSIST
Entity type:Organization
Organization Name:TEXAS INDEPENDENT FIRST ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:MANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:940-206-1069
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:RHOME
Mailing Address - State:TX
Mailing Address - Zip Code:76078-0129
Mailing Address - Country:US
Mailing Address - Phone:940-206-1069
Mailing Address - Fax:
Practice Address - Street 1:1901 FM 718
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:TX
Practice Address - Zip Code:76078-5213
Practice Address - Country:US
Practice Address - Phone:940-206-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty