East Texas Infectious Disease Consultants, PLLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

207R10200X Issued in TX

Legal business name

EAST TEXAS INFECTIOUS DISEASE CONSULTANTS, PLLC

Practice address

935 S Baxter Ave
Ste 103
Tyler, TX 75701-2245

Phone

(903) 592-4473

Fax

(903) 592-4474

NPI assigned

Jul 28, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Carol Conover

Title

Administrator

Phone

(903) 592-4473

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

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

• June Belt, NP

  • Physician Assistant
  • Tyler, TX
  • NPI 1497708960
  Medicare reassignment Care Compare group NPD
• Katheryn Green, NP

  • Family Nurse Practitioner
  • Chandler, TX
  • NPI 1891734489
  Medicare reassignment Care Compare group NPD
• Steven L. Hickerson, M.D.

  • Infectious Disease Physician
  • Tyler, TX
  • NPI 1376543546
  Medicare reassignment Care Compare group NPD
• Dena Elizabeth Schueler, RN, FNP-C

  • Family Nurse Practitioner
  • Tyler, TX
  • NPI 1881944304
  Medicare reassignment Care Compare group NPD
• Richard R Yates, MD

  • Infectious Disease Physician
  • Tyler, TX
  • NPI 1972503209
  Medicare reassignment Care Compare group
• Alicia Rose Adkison, FNP

  • Family Nurse Practitioner
  • Tyler, TX
  • NPI 1104287929
  Medicare reassignment NPD
• Deborah (Debbie) Ann Bridges, MD

  • Infectious Disease Physician
  • Dallas, TX
  • NPI 1821054776
  Medicare reassignment NPD
• Mariejane Braza, MD

  • Infectious Disease Physician
  • Vero Beach, FL
  • NPI 1144467515

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1912907353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 131629",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757131629",
            "telephone_number": "903-592-4473",
            "fax_number": "903-592-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 S BAXTER AVE",
            "address_2": "STE 103",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012245",
            "telephone_number": "903-592-4473",
            "fax_number": "903-592-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS INFECTIOUS DISEASE CONSULTANTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "CONOVER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-592-4473",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TX",
            "license": "207R10200X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157701701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Infectious Disease Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Infectious Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.