| Tyler Clinic | |
|
1300 Clinic Dr Tyler TX 75701-2119 | |
| (903) 597-7558 | |
| (903) 597-9107 |
| Full Name | Tyler Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 Clinic Dr, Tyler, Texas |
| Authorized Official Name and Position | Kim Nesvig (INTERIM EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9032340776 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Clinic Po Box 2709 Longview TX 75606-2709 Ph: (903) 234-0776 | Tyler Clinic 1300 Clinic Dr Tyler TX 75701-2119 Ph: (903) 597-7558 |
| NPI Number | 1609298132 |
|---|---|
| Provider Enumeration Date | 01/17/2014 |
| Last Update Date | 01/05/2023 |
| Medicare PECOS PAC ID | 1355326158 |
|---|---|
| Medicare Enrollment ID | O20150818003564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609298132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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