Healthcare Provider Details

I. General information

NPI: 1760128995
Provider Name (Legal Business Name): ADVANCED HEALTH CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WSW LOOP 323 STE 60
TYLER TX
75701-7059
US

IV. Provider business mailing address

1400 WSW LOOP 323 STE 60
TYLER TX
75701-7059
US

V. Phone/Fax

Practice location:
  • Phone: 903-526-4875
  • Fax: 903-526-4876
Mailing address:
  • Phone: 903-526-4875
  • Fax: 903-526-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JANET RENE KEAIS
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 903-830-9222