WYRICK DERMATOLOGY ASSOCIATION
NPI 1619977295
Clinic/Center in Texarkana, TX
NPI Status: Active since July 26, 2005
Contact Information
3333 POTOMAC AVE
TEXARKANA, TX
ZIP 75503
Phone: (903) 792-3787
Fax: (903) 792-0446
- Organization
- Clinic/Center
- Accepts Insurance
- CLIA Number: 45D0482485
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-31-2026
About WYRICK DERMATOLOGY ASSOCIATION
This page provides the complete NPI Profile along with additional information for Wyrick Dermatology Association, a provider established in Texarkana, Texas operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1619977295 assigned on July 2005. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Scott W Wyrick M.d. (President)
- NPI
- 1619977295
- Provider Name
- WYRICK DERMATOLOGY ASSOCIATION
- Entity Type
- Organization
- Location Address
- 3333 POTOMAC AVE TEXARKANA, TX 75503
- Location Phone
- (903) 792-3787
- Location Fax
- (903) 792-0446
- Mailing Address
- 3333 POTOMAC AVE TEXARKANA, TX 75503
- Mailing Phone
- (903) 792-3787
- Mailing Fax
- (903) 792-0446
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-26-2005
- Last Update Date
- 04-09-2013
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Clear Silver - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Silver - HMO
- Complete Silver + Vision + Adult Dental - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Choice Bronze HSA (QualChoice) - POS
- Complete Gold - PPO
- Complete Gold + Vision + Adult Dental - PPO
- Complete Silver (QualChoice) - POS
- Connected Silver - PPO
- Connected Silver (QualChoice) - POS
- Connected Silver (QualChoiceLife) - PPO
- Connected Silver + Vision + Adult Dental - PPO
- Elite Bronze - PPO
- Elite Bronze + Vision + Adult Dental - PPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Complete Silver - EPO
- Complete Silver + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Standard Gold - EPO
- Standard Gold + Vision + Adult Dental - EPO
- Elite Bronze - PPO
- Elite Bronze + Vision + Adult Dental - PPO
- Elite Gold - PPO
- Elite Gold + Vision + Adult Dental - PPO
- Everyday Bronze - PPO
- Everyday Bronze + Vision + Adult Dental - PPO
- Everyday Gold - PPO
- Everyday Gold + Vision + Adult Dental - PPO
- Focused Silver - PPO
- Focused Silver + Vision + Adult Dental - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00360N | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | PROVIDER IDENTIFICATION |
| 109371802 | MEDICAID (05) | TX | |
| 145002002 | MEDICAID (05) | AR |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D0482485
- Facility Type
- Physician Office
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- WALTER WYRICK JR MD
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Wyrick Dermatology Association in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 6 | 1 | 9 | 9 | 7 | 7 | 2 | 9 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 6 | 2 | 9 | 18 | 7 | 14 | 2 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 6 + 2 + 9 + 1 + 8 + 7 + 1 + 4 + 2 + 1 + 8 + 24 = 75 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 75 = 5 | 5 | ||||||||
The NPI number 1619977295 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1942232087 | LENORE P WYRICK RN, FNP Individual | Nurse Practitioner (Family) | 3333 POTOMAC AVE TEXARKANA, TX 75503 (903) 792-3787 |
| 1114920972 | SCOTT W WYRICK M.D. Individual | Family Medicine | 3333 POTOMAC AVE TEXARKANA, TX 75503 (903) 792-3787 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1619977295, enumerated in the NPI registry as an "organization" on July 26, 2005
The provider is located at 3333 Potomac Ave Texarkana, Tx 75503 and the phone number is (903) 792-3787
This medical organization specializes in Clinic/Center with taxonomy code 261Q00000X
The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Ambetter. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 45D0482485 for a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on July 26, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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