Healthcare Provider Details

I. General information

NPI: 1730513672
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER QUITMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 TITUS ST
GILMER TX
75644-1738
US

IV. Provider business mailing address

PO BOX 1304
PITTSBURG TX
75686-2203
US

V. Phone/Fax

Practice location:
  • Phone: 903-841-7300
  • Fax: 903-841-7373
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM P HENDERSON
Title or Position: SENIOR ADMINISTRATOR
Credential:
Phone: 903-946-5519