Black Tie Ball
Credit Card Payment


First Name: *
Last Name: *
My primary Texas Health Resources hospital will be / is: *
Indicate below the Texas Health Resources facilities to which you are applying. Pay the initial or reappointment fee as indicated below.
Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment




AHP Initial

AHP Reappointment




Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment




AHP Initial

AHP Reappointment




Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment


AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Physician Initial

Physician Reappointment

AHP Initial

AHP Reappointment

Use this option if you wish to make a one-time user specified payment:




Payment Information

*** Amount *  



Card Type:


Please enter information below exactly as it appears on the credit card.

Cardholder Name: *
Card Number: *
Expiration Date: * Year
Credit Card Billing Address: *
Credit Card Billing City: *
Credit Card Billing State: *
Credit Card Billing Zip Code: *

Please enter authentication challenge characters below and click Submit button only once.

 
Texas Health Resources Credentialing Payment
Arlington, TX 76011
817-250-3680
This page is displayed via a secure connection that can be confirmed by noting the “https” prefix in the URL and, in Internet Explorer, by appearance of a Secure Sockets Layer (SSL) padlock icon in the browser status bar at lower right. Any information you exchange with this site is protected from view by other Internet users. Any e-mail addresses you enter may be used to send you a verification message, but such addresses will not be used to request personal information of any type nor will any contact details be shared with other companies. See the Texas Health Resources Privacy Statement for more details. Texas Health uses industry-standard encryption technologies when transferring and receiving payment data. If you have questions regarding this page, please contact us for more information.