Healthcare Provider Details

I. General information

NPI: 1760803894
Provider Name (Legal Business Name): ETMC SURGICAL FIRST ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

PO BOX 6720
TYLER TX
75711-6720
US

V. Phone/Fax

Practice location:
  • Phone: 903-531-8010
  • Fax:
Mailing address:
  • Phone: 903-531-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name: BYRON C HALE
Title or Position: SVP/CFO
Credential:
Phone: 903-531-8010