TYLER REGIONAL HOSPITAL LLC (NPI# 1063915916) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063915916 |
| Entity Type | Organization |
| Organization Name | TYLER REGIONAL HOSPITAL LLC |
| Other Organization Name | UT HEALTH EAST TEXAS TYLER REGIONAL HOSPITAL |
| Practice Address |
1000 S Beckham Ave Tyler TX 75701-1908 |
| Mailing Address |
1 Burton Hills Blvd Ste 250 Nashville TN 37215-6195 |
| Practice Telephone | 9035970351 |
| Practice Fax Number | 9035356334 |
| Mailing Telephone | 6152963000 |
| Mailing Fax Number | 6152966227 |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-16 |
| Authorized Official Name | STEPHEN C. PETROVICH (EVP) |
| Authorized Official Telephone | 6152963000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0127X |
Surgery Specialization: Trauma Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UT Health East Texas Tyler Regional Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437650264 | Tyler Regional Hospital LLC | Nurse Anesthetist, Certified Registered | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-02-27 |
| 1407364847 | Tyler Regional Hospital LLC | General Acute Care Hospital | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-01-19 |
| Street Address |
1000 S BECKHAM AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75701-1908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740280510 | Aleksandra Olsson-detwiler | Internal Medicine | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2005-07-22 |
| 1831706431 | Kalana Sanders | Registered Nurse | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-09-28 |
| 1992333975 | Graceanne M. Dimon | Physical Therapist | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-03-27 |
| 1760021976 | Gerardo Tapia Hernandez | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-01-06 |
| 1861950057 | Brittany Mason Ferguson | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2019-03-06 |
| 1255801189 | Shane Ashley Correa | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-12-04 |
| 1174000962 | David Matthew Burkland | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-07-24 |
| 1598251209 | Kelsey Rene Morton | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-07-05 |
| 1437650264 | Tyler Regional Hospital LLC | Nurse Anesthetist, Certified Registered | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-02-27 |
| 1407364847 | Tyler Regional Hospital LLC | General Acute Care Hospital | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-01-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 2086S0127X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Trauma Surgery |
| Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. |
| Notes: Source: American Board of Surgery, 2007 [1/1/2008: definition added, source added] Additional Resources: http://www.absurgery.org/. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184671190 | Mother Frances Hospital | Surgery | 612 S Fleishel Ave, Tyler, TX 75701-2012 | 2006-05-27 |
| 1871735852 | Melissa E Cloonan | Surgery | 910 E Houston St, Ste. 530, Tyler, TX 75702-8369 | 2009-04-06 |
| 1861417552 | David H Villarreal | Surgery | 1020 E Idel St, Tyler, TX 75701-2024 | 2006-07-13 |
| 1730131681 | Luis G Fernandez | Surgery | 910 E Houston St, Ste 530, Tyler, TX 75702-8369 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174034623 | Stat Trauma & Surgical Services, Pllc | Surgery | 6 Garden Ln, Arlington, TX 76016 | 2017-10-23 |
| 1487164604 | Urgent Specialty Associates Pllc | Surgery | 4100 Spring Valley Rd Ste 250, Farmers Branch, TX 75244-3645 | 2017-10-02 |
| 1578969788 | Advanced Fracture Care Solutions Pllc | Surgery | 2145 Sutton Pl, Plano, TX 75093-4323 | 2014-11-16 |
| 1952737371 | Ernest A Gonzalez Md Pa | Surgery | 12319 N Mopac Expy Ste 350, Austin, TX 78758-2512 | 2013-09-17 |
| 1831393735 | Alexander Laurance Eastman | Surgery | 5323 Harry Hines Blvd # Mc9158, Department of Surgery--btcc, Dallas, TX 75390-9158 | 2007-06-13 |
| 1669592242 | Surgical Consultants Pa | Surgery | 6210 Wooldridge Rd Ste A, Corpus Christi, TX 78414-2528 | 2007-03-29 |
| 1144240508 | Ted R. Smith | Surgery | 50 Hillcrest Medical Blvd Ste 105, Waco, TX 76712-8953 | 2006-07-20 |
| 1750310520 | Matthew A Lovitt | Surgery | 2710 Swiss Avenue, Dallas, TX 75204-5900 | 2006-07-02 |
| 1730115270 | Jimie Dianne Owsley | Surgery | 810 Morgan Ave Apt 1, Corpus Christi, TX 78404-2058 | 2006-06-25 |
| 1578500815 | Advanced Laparoendoscopic Surgery, Pllc | Surgery | 3005 West Loop S, Suite 225, Houston, TX 77027-6100 | 2006-06-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.