Organization
TYLER CARDIOVASCULAR CONSULTANTS P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THADDEUS R TOLLESON M.D. (PRESIDENT)
(903) 595-5514
Entity
Organization
Contact information
Practice address
2608 MCDONALD RD STE 100, TYLER, TX 75701-5934
(903) 595-5514
Mailing address
2608 MCDONALD RD STE 100, TYLER, TX 75701-5934
(903) 595-5514
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00065K
BCBS OF TEXAS
TX
05
—
079756501
—
TX
Enumeration date
09/12/2005
Last updated
07/22/2015
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