MEDICARE: MOTHER FRANCES HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1912953084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHER FRANCES HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 841656
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284
Country	:	US
Telephone Number	:	903-531-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5414 SOUTH BROADWAY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703
Country	:	US
Telephone Number	:	903-531-1601
Fax Number	:	903-581-1638

Authorized Official
Title or Position	:	DIRECTOR CENTRAL CREDENTIALING AND
Name	:	TINA M TILLMAN
Credential	:	CPCS CPMSM
Telephone Number	:	903-531-5784

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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Directions to “MOTHER FRANCES HOSPITAL ” Practice Location

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