Exceptional Healthcare Tyler LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

Legal business name

EXCEPTIONAL HEALTHCARE TYLER LLC

Practice address

2222 E Southeast Loop 323
Tyler, TX 75701-8320

Phone

(469) 341-7800

NPI assigned

Mar 9, 2020

Last updated

Aug 19, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Saeed S Mahboubi

Title

Ceo

Phone

(469) 341-7800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770118879. Details of each certification follow.

• CCN 670299 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 670299

Legal name

EXCEPTIONAL HEALTHCARE TYLER

Certification status

Terminated Voluntary: merger or closure, May 11, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Mar 8, 2021

Last certification

Mar 8, 2021

Beds

1

Ownership / control type

Private (not for profit)

Facility address

2222 E Southeast Loop 323
Tyler, TX 75701

Locations

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1770118879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3514 CEDAR SPRINGS RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194901",
            "telephone_number": "469-341-7800",
            "fax_number": "469-341-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 E SOUTHEAST LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018320",
            "telephone_number": "469-341-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEPTIONAL HEALTHCARE TYLER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "MAHBOUBI",
        "authorized_official_first_name": "SAEED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-341-7800"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emergency Care Clinic/Center in Tyler, TX
• Providers in Tyler, TX by specialty
• Emergency Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.