| Advanced Health Center Pllc | |
|
1400 Wsw Loop 323 Ste 60 Tyler TX 75701-7059 | |
| (903) 526-4875 | |
| (903) 526-4876 |
| Full Name | Advanced Health Center Pllc |
|---|---|
| Speciality | Integrative Medicine |
| Location | 1400 Wsw Loop 323 Ste 60, Tyler, Texas |
| Authorized Official Name and Position | Janet Rene Keais (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9038309222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Health Center Pllc 1400 Wsw Loop 323 Ste 60 Tyler TX 75701-7059 Ph: (903) 526-4875 | Advanced Health Center Pllc 1400 Wsw Loop 323 Ste 60 Tyler TX 75701-7059 Ph: (903) 526-4875 |
| NPI Number | 1760128995 |
|---|---|
| Provider Enumeration Date | 05/10/2022 |
| Last Update Date | 08/15/2022 |
| Medicare PECOS PAC ID | 6305228131 |
|---|---|
| Medicare Enrollment ID | O20220727000030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760128995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 202D00000X | Integrative Medicine | (* (Not Available)) | Primary |
| Provider Name | Janet Rene Keais-gross |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1649235490 PECOS PAC ID: 2264536580 Enrollment ID: I20091214000779 |
| Provider Name | Natalie N Starkey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356711808 PECOS PAC ID: 8628379732 Enrollment ID: I20151215001052 |
| Provider Name | Travis T Squyres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871044115 PECOS PAC ID: 9032499736 Enrollment ID: I20161215002143 |
| Provider Name | Daniel L Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912492927 PECOS PAC ID: 4486999885 Enrollment ID: I20181212002846 |
| Provider Name | Kimberly L Mabry-paroline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104460328 PECOS PAC ID: 4880029537 Enrollment ID: I20200127002031 |
| Provider Name | Vance Hale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780324442 PECOS PAC ID: 8224036157 Enrollment ID: I20220507000208 |
| Provider Name | Chiniqua L Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861265233 PECOS PAC ID: 4082158571 Enrollment ID: I20240625003373 |
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