Provider Demographics
NPI:1366221251
Name:BAROMED HBO LLC
Entity type:Organization
Organization Name:BAROMED HBO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOHR
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-839-3600
Mailing Address - Street 1:17521 US HIGHWAY 69 S STE 120
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5596
Mailing Address - Country:US
Mailing Address - Phone:903-839-3600
Mailing Address - Fax:903-839-4100
Practice Address - Street 1:456 STATE HWY 121
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:214-507-4909
Practice Address - Fax:903-839-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center