OLIVER STREET DERMATOLOGY ASC LLC NPI 1700822335

NPI Information

NPI: 1700822335
Provider Name: OLIVER STREET DERMATOLOGY ASC LLC

Doing Business As: DERMATOLOGY SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
1367 DOMINION PLAZA
TYLER, TX
ZIP 75703
Phone: (903) 534-6200
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OLIVER STREET DERMATOLOGY ASC LLC is an ambulatory surgical clinic center in Tyler, TX. OLIVER STREET DERMATOLOGY ASC LLC NPI is 1700822335. The provider is registered as an organization entity type.
The provider Is Doing Business As Dermatology Surgery Center.

The provider's business location address is:

1367 DOMINION PLAZA
TYLER, TX
ZIP 75703-013
Phone: (903) 534-6200
Fax: (903) 939-0755

The provider's authorized official is Andrea Lynne Stein .
The authorized official title is Practice Administrator and has the following contact phone number (903) 534-6200.

The CLIA number assigned to this NPI record is 45D0913170 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 6/21/2006 and was last updated on 2/6/2013.

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	261QA1903X	Clinic/Center	Ambulatory Surgical	007937	TEXAS	Yes

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	P00044713	OTHER	TEXAS	RAILROAD MEDICARE PTAN
2	162384501	MEDICAID	TEXAS
3	ASC177	MEDICARE PIN	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

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