Healthcare Provider Details

I. General information

NPI: 1629087630
Provider Name (Legal Business Name): EAST TEXAS FAMILY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N MARGARET AVE
KIRBYVILLE TX
75956-1652
US

IV. Provider business mailing address

1905 N MARGARET AVE
KIRBYVILLE TX
75956-1652
US

V. Phone/Fax

Practice location:
  • Phone: 409-420-0816
  • Fax: 409-420-0821
Mailing address:
  • Phone: 409-420-0816
  • Fax: 409-420-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number673880
License Number StateTX

VIII. Authorized Official

Name: KALYAN K RATH
Title or Position: OWNER
Credential: MD
Phone: 409-384-9200