MEDICARE: EAST TEXAS CLINICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336C0003X	Community/Retail Pharmacy	31457	TX

General Provider Information

NPI Number	:	1386873792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST TEXAS CLINICAL SERVICES

Provider Business Mailing Address
First Line	:	3251 I-45 NORTH
Second Line	:	SUITE 190
City	:	CONROE
State	:	TX
Zip	:	77304
Country	:	US
Telephone Number	:	936-788-7700
Fax Number	:	936-788-7717

Provider Business Practice Location Address
First Line	:	3251 I-45 NORTH
Second Line	:	SUITE 190
City	:	CONROE
State	:	TX
Zip	:	77304
Country	:	US
Telephone Number	:	936-788-7700
Fax Number	:	936-788-7717

Authorized Official
Title or Position	:	C.O.O.
Name	:	CYNTHIA WEST
Credential	:
Telephone Number	:	832-246-8006

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	07/21/2022

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Directions to “EAST TEXAS CLINICAL SERVICES ” Practice Location

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