Provider Demographics
NPI:1770242984
Name:EAST TEXAS HOME MEDICAL AND HOME MODIFICATIONS
Entity Type:Organization
Organization Name:EAST TEXAS HOME MEDICAL AND HOME MODIFICATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-617-8800
Mailing Address - Street 1:16568 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7338
Mailing Address - Country:US
Mailing Address - Phone:903-617-8800
Mailing Address - Fax:903-630-2402
Practice Address - Street 1:16568 KINGSTON CT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7338
Practice Address - Country:US
Practice Address - Phone:903-617-8800
Practice Address - Fax:903-630-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies