Organization
COMMUNITY HEALTH CLINICS OF NORTHEAST TEXAS
Active
Other names
Total Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN F WILDER (CFO)
(903) 533-7400
Entity
Organization
Contact information
Practice address
928 N GLENWOOD BLVD, TYLER, TX 75702-5055
(903) 533-7400
(903) 533-7409
Mailing address
928 N GLENWOOD BLVD, TYLER, TX 75702-5055
(903) 533-7400
(903) 533-7409
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190650501
—
TX
Enumeration date
11/09/2007
Last updated
06/21/2010
Update your record
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