NPIMap

Organization Active NPI

Lifetime Health Center

  • Physician Assistant
  • Tyler, TX
National Provider Identifier
1629489042
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01101 Issued in TX
Legal business name
LIFETIME HEALTH CENTER
Practice address
1420 WSW Loop 323
Suite 100
Tyler, TX 75701-9347
Phone
(903) 534-0773
Fax
(903) 534-0880
NPI assigned
May 20, 2014
Organization subpart
Yes
Parent organization
LIFETIME HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Authorized official

Name
Rene McCarty, PA-C
Title
Owner
Phone
(903) 534-0773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA01101 TX Primary

Addresses

Primary practice location

1420 WSW Loop 323
Suite 100
Tyler, TX 75701-9347

Mailing address

1420 WSW Loop 323
Suite 100
Tyler, TX 75701-9347
Phone (903) 534-0773

National Provider Directory

National Provider Directory
Part of
Lifetime Health Center

Locations

1420 Wsw Loop 323
Ste 100
Tyler, TX 75701
Phone (903) 534-0773

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1629489042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 WSW LOOP 323",
            "address_2": "SUITE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019347",
            "telephone_number": "903-534-0773",
            "fax_number": "903-534-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 WSW LOOP 323",
            "address_2": "SUITE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019347",
            "telephone_number": "903-534-0773",
            "fax_number": "903-534-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFETIME HEALTH CENTER",
        "enumeration_date": "2014-05-20",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "MCCARTY",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-534-0773",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.