| Family Healthcare Of East Tx | |
|
1304 Doctors Dr Tyler TX 75701-2262 | |
| (903) 526-6963 | |
| (903) 531-2320 |
| Full Name | Family Healthcare Of East Tx |
|---|---|
| Speciality | Family Medicine |
| Location | 1304 Doctors Dr, Tyler, Texas |
| Authorized Official Name and Position | Joy Johnson (OFFICE MANAGER) |
| Authorized Official Contact | 9035266963 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Healthcare Of East Tx 1304 Doctors Dr Tyler TX 75701-2262 Ph: (903) 526-6963 | Family Healthcare Of East Tx 1304 Doctors Dr Tyler TX 75701-2262 Ph: (903) 526-6963 |
| NPI Number | 1154329795 |
|---|---|
| Provider Enumeration Date | 07/08/2005 |
| Last Update Date | 01/10/2012 |
| Medicare PECOS PAC ID | 3072503549 |
|---|---|
| Medicare Enrollment ID | O20040517000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154329795 | NPI | - | NPPES |
| 150860801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K2341 (Texas) | Primary |
| Provider Name | Kenneth D Haygood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326046616 PECOS PAC ID: 9335139807 Enrollment ID: I20101008000648 |
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