Provider Demographics
NPI:1639808538
Name:EASTERN ELM, PLLC
Entity Type:Organization
Organization Name:EASTERN ELM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR REVENUE CYCLE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-566-1232
Mailing Address - Street 1:1005 S CROWLEY RD STE Q
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3698
Mailing Address - Country:US
Mailing Address - Phone:817-566-1232
Mailing Address - Fax:
Practice Address - Street 1:728 WEST CENTERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041
Practice Address - Country:US
Practice Address - Phone:817-566-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care