Healthcare Provider Details

I. General information

NPI: 1679657704
Provider Name (Legal Business Name): TITUS REGIONAL MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N JEFFERSON AVE STE #132
MT PLEASANT TX
75455-2387
US

IV. Provider business mailing address

2001 N JEFFERSON AVE STE #132
MT PLEASANT TX
75455-2387
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-6418
  • Fax: 903-572-6883
Mailing address:
  • Phone: 903-572-6418
  • Fax: 903-572-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11419
License Number StateTX

VIII. Authorized Official

Name: MR. TERRY SCOGGIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 903-577-6066