Provider Demographics
NPI:1396387890
Name:TOM LORREN III PC
Entity Type:Organization
Organization Name:TOM LORREN III PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LORREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-747-8488
Mailing Address - Street 1:6850 COUNTY ROAD 4328
Mailing Address - Street 2:
Mailing Address - City:LARUE
Mailing Address - State:TX
Mailing Address - Zip Code:75770-4375
Mailing Address - Country:US
Mailing Address - Phone:903-747-8488
Mailing Address - Fax:888-330-1060
Practice Address - Street 1:508 S SPRING AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8140
Practice Address - Country:US
Practice Address - Phone:903-747-8488
Practice Address - Fax:888-330-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy