Provider Demographics
NPI:1750317186
Name:TIJERINA UROLOGY CLINIC, PA
Entity Type:Organization
Organization Name:TIJERINA UROLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-785-0338
Mailing Address - Street 1:811 E AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-7353
Mailing Address - Country:US
Mailing Address - Phone:903-785-0338
Mailing Address - Fax:903-785-5369
Practice Address - Street 1:811 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-7353
Practice Address - Country:US
Practice Address - Phone:903-785-0338
Practice Address - Fax:903-785-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG5142OtherRAILROAD MEDICARE
TX094907501Medicaid
TX00JH44Medicare PIN