Provider Demographics
NPI:1265493266
Name:TYLER OBSTETRICS AND GYNECOLOGY L L P
Entity type:Organization
Organization Name:TYLER OBSTETRICS AND GYNECOLOGY L L P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BESSIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-593-2468
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:STE 602
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-593-2468
Mailing Address - Fax:903-595-4181
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:STE 602
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-593-2468
Practice Address - Fax:903-595-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085624701Medicaid
TX00U33BOtherMEDICARE