| Phoenix Health Center | |
|
1114 W Bow St Tyler TX 75702-5137 | |
| (903) 595-5595 | |
| (903) 595-5985 |
| Full Name | Phoenix Health Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1114 W Bow St, Tyler, Texas |
| Authorized Official Name and Position | Dorothy Louise Jackson (SOLE OWNER) |
| Authorized Official Contact | 9035955595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Health Center 1114 W Bow St Tyler TX 75702-5137 Ph: (903) 595-5595 | Phoenix Health Center 1114 W Bow St Tyler TX 75702-5137 Ph: (903) 595-5595 |
| NPI Number | 1295157337 |
|---|---|
| Provider Enumeration Date | 01/08/2014 |
| Last Update Date | 06/24/2014 |
| Medicare PECOS PAC ID | 8426278185 |
|---|---|
| Medicare Enrollment ID | O20140930002209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295157337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N1355 (Texas) | Primary |
| Provider Name | Dorothy L Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922071042 PECOS PAC ID: 7810059730 Enrollment ID: I20081230000449 |
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