Healthcare Provider Details

I. General information

NPI: 1457216665
Provider Name (Legal Business Name): EAST TEXAS COMMUNITY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S UNIVERSITY DR STE 100
NACOGDOCHES TX
75961-6486
US

IV. Provider business mailing address

PO BOX 632040
NACOGDOCHES TX
75963-2040
US

V. Phone/Fax

Practice location:
  • Phone: 936-585-7098
  • Fax:
Mailing address:
  • Phone: 936-560-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINDA SIMPSON FULLER
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 936-585-7121