| Groups Recover Together (texas), P.a. | |
|
4801 Troup Hwy Ste 101 Tyler TX 75703-2358 | |
| (800) 683-8313 | |
| Not Available |
| Full Name | Groups Recover Together (texas), P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4801 Troup Hwy Ste 101, Tyler, Texas |
| Authorized Official Name and Position | Colleen Nicewicz (CEO) |
| Authorized Official Contact | 4132813035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Groups Recover Together (texas), P.a. 111 S Bedford St Burlington MA 01803-6807 Ph: () - | Groups Recover Together (texas), P.a. 4801 Troup Hwy Ste 101 Tyler TX 75703-2358 Ph: (800) 683-8313 |
| NPI Number | 1679288963 |
|---|---|
| Provider Enumeration Date | 01/20/2023 |
| Last Update Date | 02/13/2023 |
| Medicare PECOS PAC ID | 3072952035 |
|---|---|
| Medicare Enrollment ID | O20240423004542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679288963 | NPI | - | NPPES |
| Provider Name | Janet Jimmerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992089940 PECOS PAC ID: 7618141730 Enrollment ID: I20111129000272 |
| Provider Name | Ifeoma Juliet Ezeigwe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104329218 PECOS PAC ID: 8022432798 Enrollment ID: I20200728002168 |
| Provider Name | Blaise Denver Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114671500 PECOS PAC ID: 4082098512 Enrollment ID: I20220901002890 |
| Provider Name | Jose Maria Partida Corona |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1477518801 PECOS PAC ID: 0941221873 Enrollment ID: I20240423004551 |
| Provider Name | Tony Lynn Hallmark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134751407 PECOS PAC ID: 9335683929 Enrollment ID: I20240708001542 |
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