Provider Demographics
NPI:1609298132
Name:SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
Entity Type:Organization
Organization Name:SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
Other - Org Name:TYLER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NESVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-234-0776
Mailing Address - Street 1:PO BOX 2709
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-2709
Mailing Address - Country:US
Mailing Address - Phone:903-234-0776
Mailing Address - Fax:903-234-9769
Practice Address - Street 1:1300 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2119
Practice Address - Country:US
Practice Address - Phone:903-597-7558
Practice Address - Fax:903-597-9107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL HEALTH RESOURCES FOR TEXAS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-17
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)