Organization
ST PAUL CHILDREN'S MEDICAL CORPORATION
Active
Other names
Bethesda Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
CHELSEA COHEN (DIRECTOR OF CLINIC OPERATIONS)
(903) 871-0939
Entity
Organization
Contact information
Practice address
132 S HORACE AVE, TYLER, TX 75702-6159
(903) 593-7607
(903) 593-3965
Mailing address
132 S HORACE AVE, TYLER, TX 75702-6159
(903) 593-7607
(903) 593-3965
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203763201
—
TX
01
—
203763202
MEDICAID-CSCHN
TX
01
—
G6063601
DELTA DENTAL- CHIPS
TX
Enumeration date
06/18/2009
Last updated
02/19/2025
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