| East Texas Neurology | |
|
1301 Doctors Dr Tyler TX 75701-2239 | |
| (903) 597-3787 | |
| Not Available |
| Full Name | East Texas Neurology |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1301 Doctors Dr, Tyler, Texas |
| Authorized Official Name and Position | Kathi Vance (OFFICE MANAGER) |
| Authorized Official Contact | 9035973787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Neurology 1301 Doctors Dr Tyler TX 75701-2239 Ph: (903) 597-3787 | East Texas Neurology 1301 Doctors Dr Tyler TX 75701-2239 Ph: (903) 597-3787 |
| NPI Number | 1841564929 |
|---|---|
| Provider Enumeration Date | 03/07/2012 |
| Last Update Date | 03/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841564929 | NPI | - | NPPES |
| 130010459 | Other | RAILROAD MEDICARE | |
| 1609803436 | Other | NPI | |
| 826133177 | Other | RAILROAD MEDICARE | |
| 00P572 | Other | BLUE CROSS | |
| 128085101 | Medicaid | TX | |
| 00ET94 | Other | BLUE CROSS | |
| 135730301 | Medicaid | TX | |
| 1184652141 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | E2095 (Texas) | Primary |
| 2084N0400X | Psychiatry & Neurology - Neurology | D7080 (Texas) | Secondary |
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