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General NPI Number Information
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NPI Number | 1942011903
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Entity Type | Organization
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Legal Business Name | TYLER FAMILY CIRCLE OF CARE
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 928 N GLENWOOD BLVD
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City | TYLER
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State | TX
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Zip | 75702-5055
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Country | US
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Telephone | 903-535-9041
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Fax | 903-533-0726
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Provider Business Mailing Address
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Address Line | 523 S FANNIN AVE
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City | TYLER
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State | TX
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Zip | 75702-8204
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Country | US
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Telephone | 903-535-9041
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | GWEN HALL
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Credential |
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Telephone | 903-535-9041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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