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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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