Organization
AZALEA ORTHOPEDIC & SPORTS MEDICINE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI EBERT (BILLING SUPERVISOR)
(903) 939-7774
Entity
Organization
Contact information
Practice address
3414 GOLDEN ROAD, TYLER, TX 75701
(903) 939-7500
(903) 939-7728
Mailing address
PO BOX 610307, DALLAS, TX 75261-0307
(903) 939-7500
(903) 939-7728
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
0863040001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084034001
—
TX
05
—
084034002
—
TX
Enumeration date
10/26/2005
Last updated
01/28/2019
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