Provider Demographics
NPI:1407973449
Name:JACK R. TOMLINSON
Entity Type:Organization
Organization Name:JACK R. TOMLINSON
Other - Org Name:WICHITA FALLS NEUROPSYCHIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-723-0012
Mailing Address - Street 1:2410 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4033
Mailing Address - Country:US
Mailing Address - Phone:940-723-0012
Mailing Address - Fax:940-723-2058
Practice Address - Street 1:2410 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4033
Practice Address - Country:US
Practice Address - Phone:940-723-0012
Practice Address - Fax:940-723-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX898103TC0700X
OK740103TC0700X
TXC65372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097024601Medicaid
TXOA0231OtherMEDICARE ID-TYPE UNSPECIFIED
OK100151170AMedicaid
TX033342901Medicaid
TX8F9754OtherMEDICARE ID-TYPE UNSPECIFIED
TX8F9755OtherMEDICARE ID-TYPE UNSPECIFIED
OK100841430AMedicaid
TX097024601Medicaid