Basic Information
| Provider Information | |||||||||
| NPI: | 1174771554 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS PALLIATIVE CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4111 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757016623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032663400 | ||||||||
| FaxNumber: | 9035660291 | ||||||||
| Practice Location | |||||||||
| Address1: | 4111 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757016623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032663400 | ||||||||
| FaxNumber: | 9035660291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 08/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | REAM | ||||||||
| AuthorizedOfficialFirstName: | MARJORIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9032663400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, MN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 2080H0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine | 207QH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.