Provider Demographics
NPI:1982765657
Name:MTR OF TYLER DBA BELTONE
Entity Type:Organization
Organization Name:MTR OF TYLER DBA BELTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:BCHIS
Authorized Official - Phone:903-595-5580
Mailing Address - Street 1:1400 WSW LOOP 323 STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7201
Mailing Address - Country:US
Mailing Address - Phone:903-595-5580
Mailing Address - Fax:903-526-3882
Practice Address - Street 1:1400 WSW LOOP 323 STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7201
Practice Address - Country:US
Practice Address - Phone:903-595-5580
Practice Address - Fax:903-526-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50617237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty