Provider Demographics
NPI:1538269824
Name:JERRY K. MYERS, M.D., ASSOCIATED
Entity type:Organization
Organization Name:JERRY K. MYERS, M.D., ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-696-5335
Mailing Address - Street 1:5500 KELL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1612
Mailing Address - Country:US
Mailing Address - Phone:940-696-5335
Mailing Address - Fax:940-696-1114
Practice Address - Street 1:5500 KELL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1612
Practice Address - Country:US
Practice Address - Phone:940-696-5335
Practice Address - Fax:940-696-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81720XOtherBLUE CROSS BLUE SHIELD
TXDO6534OtherRAILROAD MEDICARE
TX110622103Medicaid
TX81720XOtherBLUE CROSS BLUE SHIELD