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General NPI Number Information
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NPI Number | 1689496812
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-FACILTY-PHYSICIAN
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 102 W HENDERSON ST
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City | OVERTON
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State | TX
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Zip | 75684-1613
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Country | US
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Telephone | 903-834-0201
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Fax | 903-834-0264
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Provider Business Mailing Address
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Address Line | 11937 US HIGHWAY 271
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City | TYLER
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State | TX
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Zip | 75708-3154
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Country | US
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Telephone | 903-877-7200
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Fax |
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Authorized Official
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Title or Position | CHIEF BUSINESS OFFICER
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Name | DANIEL DESLATTE
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Credential |
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Telephone | 903-877-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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