Provider Demographics
NPI:1104369057
Name:BATES, TAMMIE
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 DOE RUN
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-4527
Mailing Address - Country:US
Mailing Address - Phone:903-732-5279
Mailing Address - Fax:903-732-5279
Practice Address - Street 1:113 DOE RUN
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:TX
Practice Address - Zip Code:75473-4527
Practice Address - Country:US
Practice Address - Phone:903-732-5279
Practice Address - Fax:903-732-5279
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator