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General NPI Number Information
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NPI Number | 1346005287
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Entity Type | Organization
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Legal Business Name | CRC MEDICAL PLLC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1043 ASHER WAY STE 300
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City | TYLER
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State | TX
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Zip | 75703-6074
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Country | US
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Telephone | 903-707-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 1043 ASHER WAY STE 300
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City | TYLER
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State | TX
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Zip | 75703-6074
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Country | US
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Telephone | 903-707-4136
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Fax | 903-326-2884
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WALTER CODY COX
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Credential | MD
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Telephone | 903-707-4136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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