Provider Demographics
NPI:1770118879
Name:EXCEPTIONAL HEALTHCARE TYLER LLC
Entity type:Organization
Organization Name:EXCEPTIONAL HEALTHCARE TYLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHBOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-341-7800
Mailing Address - Street 1:3514 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4901
Mailing Address - Country:US
Mailing Address - Phone:469-341-7800
Mailing Address - Fax:469-341-7887
Practice Address - Street 1:2222 E SOUTHEAST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8320
Practice Address - Country:US
Practice Address - Phone:469-341-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care