| Wiley Roosth MD & Associates | |
|
1025 Hospital Dr Tyler TX 75701-2023 | |
| (903) 592-8181 | |
| (903) 592-8113 |
| Full Name | Wiley Roosth MD & Associates |
|---|---|
| Speciality | Family Medicine |
| Location | 1025 Hospital Dr, Tyler, Texas |
| Authorized Official Name and Position | Wiley Roosth (CEO) |
| Authorized Official Contact | 9035928181 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wiley Roosth MD & Associates 1025 Hospital Dr Tyler TX 75701-2023 Ph: (903) 592-8181 | Wiley Roosth MD & Associates 1025 Hospital Dr Tyler TX 75701-2023 Ph: (903) 592-8181 |
| NPI Number | 1104059955 |
|---|---|
| Provider Enumeration Date | 08/27/2009 |
| Last Update Date | 08/27/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104059955 | NPI | - | NPPES |
| 030768801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | B9174 (Texas) | Primary |
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