MEDICARE: DEPARTMENT OF STATE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261QA0005X	Ambulatory Family Planning Facility	TX
2	261QF0050X	Non-Surgical Family Planning Clinic/Center	TX
3	261QP0905X	State or Local Public Health Clinic/Center	TX

General Provider Information

NPI Number	:	1003982117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF STATE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1100 W 49TH ST
Second Line	:	HSR 4&5 - TYLER
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-458-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 W FRONT ST
Second Line	:	ATTN BILLING OFFICE
City	:	TYLER
State	:	TX
Zip	:	75702-7822
Country	:	US
Telephone Number	:	903-595-3585
Fax Number	:	903-593-4187

Authorized Official
Title or Position	:	DEPUTY REGIONAL DIRECTOR
Name	:	WILLIAM OLIVER
Credential	:
Telephone Number	:	903-595-3585

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/11/2025

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Directions to “DEPARTMENT OF STATE HEALTH SERVICES ” Practice Location

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