Healthcare Provider Details

I. General information

NPI: 1891190369
Provider Name (Legal Business Name): DEUBANKS AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 RICE RD 106
TYLER TX
75703-3604
US

IV. Provider business mailing address

455 RICE RD 106
TYLER TX
75703-3604
US

V. Phone/Fax

Practice location:
  • Phone: 903-509-4327
  • Fax: 903-509-4330
Mailing address:
  • Phone: 903-509-4327
  • Fax: 903-509-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number50564
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number50564
License Number StateTX

VIII. Authorized Official

Name: MR. DELSON EARL EUBANKS
Title or Position: OWNER/HIS
Credential: HIS
Phone: 903-509-4327