Healthcare Provider Details

I. General information

NPI: 1003042458
Provider Name (Legal Business Name): CIRCULATORY DYNAMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E HOUSTON ST
TYLER TX
75702-8218
US

IV. Provider business mailing address

312 E HOUSTON ST
TYLER TX
75702-8218
US

V. Phone/Fax

Practice location:
  • Phone: 480-777-0607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name: BARBARA W PARKER
Title or Position: BILLING MANAGER
Credential:
Phone: 480-777-0607