Healthcare Provider Details

I. General information

NPI: 1679859409
Provider Name (Legal Business Name): MR. TYLER SCOTT SIMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S PALESTINE ST
ATHENS TX
75751-3322
US

IV. Provider business mailing address

603 S PALESTINE ST
ATHENS TX
75751-3322
US

V. Phone/Fax

Practice location:
  • Phone: 903-670-1290
  • Fax: 903-670-1291
Mailing address:
  • Phone: 903-670-1290
  • Fax: 903-670-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number19637724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: