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NPI Code Detail

MEDICARE: EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES

MEDICARE: EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1528234721
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 9477
Second Line :
City : TYLER
State : TX
Zip : 75711-9477
Country : US
Telephone Number : 903-594-2450
Fax Number : 903-939-0610
Provider Business Practice Location Address
First Line : 1028 E IDEL ST STE A
Second Line :
City : TYLER
State : TX
Zip : 75701-2024
Country : US
Telephone Number : 903-593-1749
Fax Number : 903-939-0610
Authorized Official
Title or Position : VICE PRESIDENT
Name : MS. KIM PEARSON-WAHL
Credential :
Telephone Number : 903-535-6890
Provider Enumeration Date : 05/07/2008
Last Update Date : 05/11/2009

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Directions to “EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES ” Practice Location

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