Provider Demographics
NPI:1982198057
Name:SPECIAL HEALTH RESOURCES FOR TEXAS INCORPORATED
Entity Type:Organization
Organization Name:SPECIAL HEALTH RESOURCES FOR TEXAS INCORPORATED
Other - Org Name:WOMEN'S HEALTH TYLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:DALE
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 1:825 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2143
Practice Address - Country:US
Practice Address - Phone:903-533-0733
Practice Address - Fax:903-939-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)