CROSSROADS TREATMENT CENTERS TYLER
NPI 1104144088
Clinic/Center - Methadone in Tyler, TX

Q: What is Methadone Clinic Of East Texas LLC's NPI number?

The NPI number for Methadone Clinic Of East Texas LLC is 1104144088. It was assigned to this organization in the NPPES registry on May 17, 2010. The provider is doing business as Crossroads Treatment Centers Tyler.

Q: What is Methadone Clinic Of East Texas LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.

Active since May 17, 2010CLIA 45D2181370 · Waiver

1510 S VINE AVE, TYLER, TX 75701(800) 805-6989 Get Directions Write a Review

NPPES record last updated: September 3, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Crossroads Treatment Centers Tyler NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CROSSROADS TREATMENT CENTERS TYLER (NPI 1104144088) is a healthcare organization registered as a methadone in Tyler, Texas and active in the NPI registry since May 2010. The organization holds a CLIA Waiver certificate valid through April 1, 2028 and lists Rupert Mccormac, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1104144088

Entity TypeOrganization

Primary Taxonomy261QM2800X

Legal Business NameMETHADONE CLINIC OF EAST TEXAS LLC

Location Address1510 S VINE AVETyler, TX 75701-2826

Mailing AddressPo Box 749057Atlanta, GA 30374-9057 · (800) 805-6989 · Fax (864) 558-8511

Phone(800) 805-6989

Organization SubpartNo

Authorized OfficialRupert MccormacChief Executive Officer · (800) 805-6898

Enumeration DateMay 17, 2010

Last NPPES UpdateSeptember 3, 2024

NPPES CertifiedSeptember 3, 2024

✔ NPI 1104144088 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyClinic/Center · MethadoneAmbulatory Health Care Facilities

Taxonomy Code261QM2800X

License✔ Licensed in TX · 000039

Definition

An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X

Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X

Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X

Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X

1510 S VINE AVE, Tyler, TX 75701

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Other Names 1

Doing Business AsCrossroads Treatment Centers Tyler

Other Identifiers 1

Medicaid2121550TX

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2181370

Methadone Clinic Of East Texas LLC Tyler · Tyler, TX

Active · expires Apr 1, 2028

CLIA Number45D2181370

Laboratory TypeOpiod Treatment Ctr

Certificate Effective DateApril 2, 2026

Certificate Expiration DateApril 1, 2028

Laboratory DirectorJames Stephen

Laboratory Phone(903) 526-4055

Laboratory LocationMethadone Clinic Of East Texas LLC Tyler1510 S Vine Ave, Tyler, TX 75701

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm G2067

Medication Assisted Treatment (MAT) with methadone is a comprehensive approach to manage opioid addiction. It includes weekly methadone dispensing, substance use counseling, individual and group therapy sessions, and toxicology tests as needed, all provided by a Medicare-enrolled opioid treatment program.

517 services25 patients

Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure G2078

This service provides an additional 7-day supply of methadone, a medication used to treat opioid addiction, for patients to take at home. It's provided by a Medicare-enrolled opioid treatment program. This service is billed separately from the main treatment procedure.

481 services20 patients

Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for G2077

Periodic assessment is a routine check-up by trained professionals to determine the best mix of services and treatments for your health needs. This is typically provided by a Medicare-enrolled opioid treatment program. It's listed separately in addition to your main treatment code. This ensures you receive the most suitable care for your situation.

20 services18 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JESSICA ANN DUNNAVANT X LCDC

Counselor (Addiction (Substance Use Disorder))