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Contact Information

AZALEA ORTHOPEDIC & SPORTS MEDICINE CLINIC PA
3414 GOLDEN ROAD
TYLER, TX75701
 Phone: 903-939-7500
 Fax: 903-939-7728
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for AZALEA ORTHOPEDIC & SPORTS MEDICINE CLINIC PA

NPI Number 1699765107
LBN Legal business name AZALEA ORTHOPEDIC & SPORTS MEDICINE CLINIC PA
Authorized official HEIDI EBERT - (BILLING SUPERVISOR)
Entity Organization
Organization subpart 1 No
Enumeration date 10/26/2005
Last updated 01/28/2019 - About 7 years ago
Identifiers
TX License # 0863040001
TX Medicaid 084034001
TX Medicaid 084034002
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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