Healthcare Provider Details

I. General information

NPI: 1255367090
Provider Name (Legal Business Name): EAST TEXAS COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S UNIVERSITY DR
NACOGDOCHES TX
75961-6488
US

IV. Provider business mailing address

PO BOX 632040
NACOGDOCHES TX
75963-2040
US

V. Phone/Fax

Practice location:
  • Phone: 936-560-5413
  • Fax: 936-552-7240
Mailing address:
  • Phone: 936-560-5413
  • Fax: 936-552-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANITA K HUMPHREYS
Title or Position: CFO
Credential:
Phone: 936-560-5413