NPIMap

Organization Active NPI

Heaton Ear Nose and Throat Associates of East Texas P a

  • Otolaryngology Physician
  • Tyler, TX
National Provider Identifier
1306988035
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
HEATON EAR NOSE AND THROAT ASSOCIATES OF EAST TEXAS P A
Practice address
1136 E Grande Blvd
Tyler, TX 75703-3982
Phone
(903) 592-5601
Fax
(903) 595-3304
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Gamble
Title
Billing Manager
Phone
(903) 592-5601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

1136 E Grande Blvd
Tyler, TX 75703-3982

Mailing address

1136 E Grande Blvd
Tyler, TX 75703-3982
Phone (903) 592-5601

Other identifiers 3

IdentifierTypeStateIssuer
085099201MedicaidTX
CA8539OtherTXPALMETTO, RR MEDICARE
00T02EOtherTXBCBS

Other names 1

  • ENT Associates of East Texas Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090120000320 TX Part B Supplier - Clinic/Group Practice 4688774482 Receives reassigned benefits from 19 practitioners
Practice locations: Athens, TX; Longview, TX; Tyler, TX

National Provider Directory

National Provider Directory

Locations

323 E Hawkins Pkwy
Ste F
Longview, TX 75605
Phone (903) 592-5601

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553212800000",
    "number": "1306988035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATON EAR NOSE AND THROAT ASSOCIATES OF EAST TEXAS P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2019-03-22",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "903-592-5601"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085099201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO, RR MEDICARE",
            "identifier": "CA8539",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00T02E",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ENT Associates of East Texas",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ENT Associates of East Texas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.