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General NPI Number Information
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NPI Number | 1467689307
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Entity Type | Organization
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Legal Business Name | ST PAUL CHILDREN'S MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 132 S HORACE AVE
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City | TYLER
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State | TX
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Zip | 75702-6159
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Country | US
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Telephone | 903-593-7607
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Fax | 903-593-3965
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Provider Business Mailing Address
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Address Line | 132 S HORACE AVE
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City | TYLER
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State | TX
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Zip | 75702-6159
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Country | US
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Telephone | 903-593-7607
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Fax | 903-593-3965
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Authorized Official
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Title or Position | DIRECTOR OF CLINIC OPERATIONS
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Name | CHELSEA COHEN
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Credential |
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Telephone | 903-871-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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