| Stephen C Spain | |
|
5040 Kinsey Dr Ste 300 Tyler TX 75703-3046 | |
| (903) 561-8300 | |
| (903) 561-8327 |
| Full Name | Stephen C Spain |
|---|---|
| Speciality | Family Medicine |
| Location | 5040 Kinsey Dr Ste 300, Tyler, Texas |
| Authorized Official Name and Position | Stephen C Spain (OWNER) |
| Authorized Official Contact | 9035618300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen C Spain 1702 Holly Creek Dr Tyler TX 75703-0907 Ph: (903) 561-8300 | Stephen C Spain 5040 Kinsey Dr Ste 300 Tyler TX 75703-3046 Ph: (903) 561-8300 |
| NPI Number | 1689718702 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/22/2026 |
| Certification Date | 08/22/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689718702 | NPI | - | NPPES |
| 010054743 | Other | RAILROAD MEDICARE | |
| 89X859 | Other | BLUE CROSS | |
| 133341103 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
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