Healthcare Provider Details

I. General information

NPI: 1740425933
Provider Name (Legal Business Name): 3 C HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WESTWAY ST
TYLER TX
75703-6464
US

IV. Provider business mailing address

PO BOX 130008
TYLER TX
75713-0008
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-4363
  • Fax: 903-526-7617
Mailing address:
  • Phone: 512-697-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0107831
License Number StateTX

VIII. Authorized Official

Name: JUDSON STURDIVANT
Title or Position: OWNER
Credential:
Phone: 512-697-9896