Healthcare Provider Details

I. General information

NPI: 1265886774
Provider Name (Legal Business Name): THOMAS M MCGOVERN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 S BAXTER AVE
TYLER TX
75701-2245
US

IV. Provider business mailing address

935 S BAXTER AVE
TYLER TX
75701-2245
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-7775
  • Fax: 903-596-7778
Mailing address:
  • Phone: 903-596-7775
  • Fax: 903-596-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberK7057
License Number StateTX

VIII. Authorized Official

Name: DR. THOMAS MICHAEL MCGOVERN
Title or Position: PRESIDENT
Credential: MD
Phone: 903-596-7775