Healthcare Provider Details

I. General information

NPI: 1528234721
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E IDEL ST STE A
TYLER TX
75701-2024
US

IV. Provider business mailing address

PO BOX 9477
TYLER TX
75711-9477
US

V. Phone/Fax

Practice location:
  • Phone: 903-593-1749
  • Fax: 903-939-0610
Mailing address:
  • Phone: 903-594-2450
  • Fax: 903-939-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM PEARSON-WAHL
Title or Position: VICE PRESIDENT
Credential:
Phone: 903-535-6890