| Magnolia Internal Medicine Associates Pa | |
|
3309 University Blvd Tyler TX 75701 | |
| (903) 565-0303 | |
| (903) 565-5446 |
| Full Name | Magnolia Internal Medicine Associates Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3309 University Blvd, Tyler, Texas |
| Authorized Official Name and Position | Denise Ione Sherman (CLINIC DIRECTOR) |
| Authorized Official Contact | 9035650303 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Internal Medicine Associates Pa 3309 University Blvd Tyler TX 75701 Ph: (903) 565-0303 | Magnolia Internal Medicine Associates Pa 3309 University Blvd Tyler TX 75701 Ph: (903) 565-0303 |
| NPI Number | 1972582385 |
|---|---|
| Provider Enumeration Date | 01/13/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3971567124 |
|---|---|
| Medicare Enrollment ID | O20041117000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972582385 | NPI | - | NPPES |
| 0057LZ | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Russell T Topham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437138005 PECOS PAC ID: 7719962554 Enrollment ID: I20040624000032 |
| Provider Name | Denise I Sherman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982682159 PECOS PAC ID: 3072426147 Enrollment ID: I20040628001403 |
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