Healthcare Provider Details

I. General information

NPI: 1699745208
Provider Name (Legal Business Name): NORTHEAST TEXAS PUBLIC HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N. BROADWAY
TYLER TX
75702-4507
US

IV. Provider business mailing address

815 N BROADWAY AVE
TYLER TX
75702-4507
US

V. Phone/Fax

Practice location:
  • Phone: 903-535-0033
  • Fax: 903-535-0052
Mailing address:
  • Phone: 903-535-0033
  • Fax: 903-535-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE T. ROBERTS JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: FACHE
Phone: 903-535-0036