NPIMap

Organization Active NPI

Northeast Texas Public Health District

  • State or Local Public Health Clinic/Center
  • Tyler, TX
National Provider Identifier
1699745208
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
NORTHEAST TEXAS PUBLIC HEALTH DISTRICT
Practice address
815 N. Broadway
Tyler, TX 75702-4507
Phone
(903) 535-0033
Fax
(903) 535-0052
NPI assigned
Jan 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Authorized official

Name
Mr. George T. Roberts Jr., FACHE
Title
Chief Executive Officer
Phone
(903) 535-0036

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

815 N. Broadway
Tyler, TX 75702-4507

Mailing address

815 N Broadway Ave
Tyler, TX 75702-4507
Phone (903) 535-0033

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040913001200 TX Part B Supplier - Clinic/Group Practice 7012984768 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1699745208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757024507",
            "telephone_number": "903-535-0033",
            "fax_number": "903-535-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N. BROADWAY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757024507",
            "telephone_number": "903-535-0033",
            "fax_number": "903-535-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST TEXAS PUBLIC HEALTH DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "903-535-0036",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "FACHE"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Sep 26, 2024; 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.