| East Texas Functional Medicine Center, Llc | |
|
419 Wsw Loop 323 Ste 400 Tyler TX 75701-7063 | |
| (903) 595-8077 | |
| (903) 363-1541 |
| Full Name | East Texas Functional Medicine Center, Llc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 419 Wsw Loop 323 Ste 400, Tyler, Texas |
| Authorized Official Name and Position | Guy Otis Danielson (MD/OWNER) |
| Authorized Official Contact | 9035958077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Functional Medicine Center, Llc 419 Wsw Loop 323 Ste 400 Tyler TX 75701-7063 Ph: (903) 595-8077 | East Texas Functional Medicine Center, Llc 419 Wsw Loop 323 Ste 400 Tyler TX 75701-7063 Ph: (903) 595-8077 |
| NPI Number | 1245847672 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 12/07/2020 |
| Medicare PECOS PAC ID | 7911319496 |
|---|---|
| Medicare Enrollment ID | O20201208001745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245847672 | NPI | - | NPPES |
| 1801905674 | Other | TX | DR. DANIELSON'S NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 2083P0901X | Preventive Medicine - Public Health & General Preventive Medicine | (* (Not Available)) | Primary |
| Provider Name | Guy O Danielson |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1801905674 PECOS PAC ID: 5092613604 Enrollment ID: I20040103000015 |
| Provider Name | Adrienne J Carmack |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1346430527 PECOS PAC ID: 1850475070 Enrollment ID: I20090223000095 |
| Provider Name | Cace S Hurt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053720748 PECOS PAC ID: 1759500424 Enrollment ID: I20140910002234 |
| Provider Name | Kevin G May |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245339183 PECOS PAC ID: 2466440722 Enrollment ID: I20140915001565 |
| Provider Name | Jessica T Morton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760833776 PECOS PAC ID: 0749577427 Enrollment ID: I20160923000087 |
| Provider Name | Carmen N Keith |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1730308065 PECOS PAC ID: 3678612819 Enrollment ID: I20200624001704 |
| Provider Name | Bradley Fisher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033703749 PECOS PAC ID: 9638578081 Enrollment ID: I20210604001281 |
| Provider Name | Adam Scott Strawbridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346928843 PECOS PAC ID: 0749630382 Enrollment ID: I20231222002053 |
Pure Radiance Laser Retreat Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6722 S Broadway Ave, Tyler, TX 75703 Phone: 903-561-0300 | |
Clifford D. Mullins, D.c., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14653 Eastside Rd, Tyler, TX 75707 Phone: 903-566-4449 | |
University Of Texas Health Science Center At Tyler-facility-physician Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11937 Us Highway 271, Tyler, TX 75708 Phone: 903-877-3451 | |
Frank P Reuter Jr Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 712 S Bois D Arc Ave, Tyler, TX 75701 Phone: 903-597-5579 Fax: 903-597-5722 | |
David W Ball Md Internal Medicine Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5407 New Copeland Rd Ste 200, Tyler, TX 75703 Phone: 903-330-2081 Fax: 903-630-9309 | |
Integrity Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5605 Old Bullard Rd Ste B, Tyler, TX 75703 Phone: 903-630-5595 Fax: 903-630-5599 | |
Serve All Medical Tyler, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 510 S Southwest Loop 323 Ste 140, Tyler, TX 75702 Phone: 903-530-0240 |