Organization
EAST TEXAS NEUROLOGY
Active
Organization
EAST TEXAS NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHI VANCE (OFFICE MANAGER)
(903) 597-3787
Entity
Organization
Contact information
Practice address
1301 DOCTORS DR, TYLER, TX 75701-2239
(903) 597-3787
Mailing address
1301 DOCTORS DR, TYLER, TX 75701-2239
(903) 597-3787
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
D7080
TX
2084N0400X
Neurology Physician
Primary
E2095
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00ET94
BLUE CROSS
—
01
—
00P572
BLUE CROSS
—
01
—
1184652141
NPI
—
05
—
128085101
—
TX
01
—
130010459
RAILROAD MEDICARE
—
05
—
135730301
—
TX
01
—
1609803436
NPI
—
01
—
826133177
RAILROAD MEDICARE
—
Enumeration date
03/07/2012
Last updated
03/07/2012
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.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up