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General NPI Number Information
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NPI Number | 1437975075
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Entity Type | Organization
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Legal Business Name | SENIORROUNDS MEDICAL, LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1910 ROSELAND BLVD
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City | TYLER
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State | TX
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Zip | 75701-4246
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Country | US
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Telephone | 903-617-2626
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Fax | 903-617-2626
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Provider Business Mailing Address
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Address Line | 1910 ROSELAND BLVD
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City | TYLER
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State | TX
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Zip | 75701-4246
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Country | US
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Telephone | 903-617-2626
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Fax | 903-617-2626
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MR. ADAM WILSON
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Credential |
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Telephone | 817-886-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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