Pure Radiance Laser Retreat

LBN: Pure Radiance Laser Retreat
Pure Radiance Laser Retreat is an health care organization with primary practice located at 6722 S Broadway Ave , Tyler TX 75703-4730. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Pure Radiance Laser Retreat can be contacted via phone (903) 561-0300, or through Stewart, Mack D via phone (903) 561-0300.

Contact Information

Primary practice address
6722 S Broadway Ave Tyler TX 75703-4730
Phone: (903) 561-0300
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Stewart, Mack D Doctor of Medicine (MD)
Phone: (903) 561-0300

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1013306273
LBN Legal business name Pure Radiance Laser Retreat
DBA Doing business as
Authorized official Stewart, Mack D Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 12th, 2015
Last updated Jan 12th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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