| Ron L Roberts Ms | |
|
606 S Fleishel Ave Tyler TX 75701-2012 | |
| (903) 581-0933 | |
| (903) 581-3977 |
| Full Name | Ron L Roberts Ms |
|---|---|
| Speciality | Clinic/Center |
| Location | 606 S Fleishel Ave, Tyler, Texas |
| Authorized Official Name and Position | Ron L Roberts (OWNER) |
| Authorized Official Contact | 9035810933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ron L Roberts Ms 1201 S Fleishel Ave Tyler TX 75701 Ph: (903) 581-0933 | Ron L Roberts Ms 606 S Fleishel Ave Tyler TX 75701-2012 Ph: (903) 581-0933 |
| NPI Number | 1053181032 |
|---|---|
| Provider Enumeration Date | 01/02/2024 |
| Last Update Date | 07/11/2024 |
| Certification Date | 07/11/2024 |
| Medicare PECOS PAC ID | 0042655615 |
|---|---|
| Medicare Enrollment ID | O20240305003021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053181032 | NPI | - | NPPES |
| 95882905 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ron L Roberts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174635379 PECOS PAC ID: 6406845460 Enrollment ID: I20240322003683 |
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