METHADONE CLINIC OF EAST TEXAS LLC NPI 1104144088

NPI Information

NPI: 1104144088
Provider Name: METHADONE CLINIC OF EAST TEXAS LLC

Doing Business As: CROSSROADS TREATMENT CENTERS TYLER

Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
1510 S VINE AVE
TYLER, TX
ZIP 75701
Phone: (800) 805-6989
Get Directions

METHADONE CLINIC OF EAST TEXAS LLC is a methadone clinic center in Tyler, TX. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. METHADONE CLINIC OF EAST TEXAS LLC NPI is 1104144088. The provider is registered as an organization entity type.
The provider Is Doing Business As Crossroads Treatment Centers Tyler.

The provider's business location address is:

1510 S VINE AVE
TYLER, TX
ZIP 75701-826
Phone: (800) 805-6989

The provider's authorized official is Rupert Mccormac .
The authorized official title is President and has the following contact phone number (800) 805-6898.

The CLIA number assigned to this NPI record is 45D2181370 - other - opiod treatment ctr with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/17/2010 and was last updated on 6/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251S00000X	Community/Behavioral Health				No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			No
3	261QM1300X	Clinic/Center	Multi-Specialty			No
4	261QM2800X	Clinic/Center	Methadone	000039	TEXAS	Yes
5	261QP2300X	Clinic/Center	Primary Care			No
6	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder		TEXAS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2121550	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »