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EAST TEXAS MEDICAL CENTER JACKSONVILLE NPI 1821366170


NPI Information

NPI: 1821366170
Provider Name: EAST TEXAS MEDICAL CENTER JACKSONVILLE

Doing Business As: ETMC FIRST PHYSICIANS CLINIC JACKSONVILLE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
203 NACOGDOCHES ST
SUITE 280
JACKSONVILLE, TX
ZIP 75766
Phone: (903) 541-5396
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EAST TEXAS MEDICAL CENTER JACKSONVILLE is a rural health clinic center in Jacksonville, TX. EAST TEXAS MEDICAL CENTER JACKSONVILLE NPI is 1821366170. The provider is registered as an organization entity type.
The provider Is Doing Business As Etmc First Physicians Clinic Jacksonville.

The provider's business location address is:

203 NACOGDOCHES ST
SUITE 280
JACKSONVILLE, TX
ZIP 75766-444
Phone: (903) 541-5396
Fax: (903) 541-5393

The provider's authorized official is Jack R Endres .
The authorized official title is Administrator and has the following contact phone number (903) 541-5100.

The enumeration date for this NPI number is 12/1/2011 and was last updated on 11/8/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR1300XClinic/CenterRural HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1130612807MEDICAIDTEXAS
2673400MEDICARE OSCAR/CERTIFICATIONTEXAS
3130612808OTHERTEXASTHSTEPS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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