Healthcare Provider Details

I. General information

NPI: 1720412141
Provider Name (Legal Business Name): TYLER FAMILY CIRCLE OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E HOUSTON ST
TYLER TX
75702-8131
US

IV. Provider business mailing address

PO BOX 844273
DALLAS TX
75284-4273
US

V. Phone/Fax

Practice location:
  • Phone: 903-535-9041
  • Fax:
Mailing address:
  • Phone: 903-535-9041
  • Fax: 903-531-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORETTA SWAN
Title or Position: BOARD CHAIRPERSON
Credential:
Phone: 903-510-1113