Healthcare Provider Details

I. General information

NPI: 1881690287
Provider Name (Legal Business Name): ARTHRITIS AND OSTEOPOROSIS CLINIC OF EAST TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 CLINIC DR
TYLER TX
75701-2117
US

IV. Provider business mailing address

1212 CLINIC DR
TYLER TX
75701-2117
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-8858
  • Fax: 903-535-9138
Mailing address:
  • Phone: 903-596-8858
  • Fax: 903-535-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG1283
License Number StateTX

VIII. Authorized Official

Name: BEBE J FOSTER
Title or Position: BILLING MANAGER
Credential:
Phone: 903-596-8858