Provider Demographics
NPI:1063463370
Name:MEDICAL TEAM CORRECTIONAL MEDICAL SERVICES MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MEDICAL TEAM CORRECTIONAL MEDICAL SERVICES MANAGEMENT, LLC
Other - Org Name:CHOICE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF GROWTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-932-1852
Mailing Address - Street 1:6760 OLD JACKSONVILLE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0572
Mailing Address - Country:US
Mailing Address - Phone:903-363-9932
Mailing Address - Fax:888-333-8977
Practice Address - Street 1:516 N SYCAMORE ST STE C
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2840
Practice Address - Country:US
Practice Address - Phone:844-266-5319
Practice Address - Fax:888-333-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000603251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
5263367OtherAETNA
HH090HOtherBLUE CROSS BLUE SHIELD
TX000603OtherDEPT OF AGING DISABILITY
969544569OtherBLUE LINK
=========OtherHEALTHFIRST
=========OtherSAFECO
HH090HOtherBLUE CROSS BLUE SHIELD
=========OtherCONSECO
=========OtherFORTIS
969544569OtherBLUE LINK
TX000603OtherDEPT OF AGING DISABILITY
=========OtherMETLIFE
=========OtherHEALTHFIRST