Provider Demographics
NPI:1194181339
Name:SYNERGISTIC HEALTH CARE
Entity Type:Organization
Organization Name:SYNERGISTIC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:903-246-3305
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-0271
Mailing Address - Country:US
Mailing Address - Phone:903-246-3305
Mailing Address - Fax:888-217-8860
Practice Address - Street 1:1930 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-2460
Practice Address - Country:US
Practice Address - Phone:903-246-3305
Practice Address - Fax:888-217-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty