Healthcare Provider Details

I. General information

NPI: 1518015908
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER PITTSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 U.S. HWY 271 N
PITTSBURG TX
75686-4289
US

IV. Provider business mailing address

PO BOX 1304
PITTSBURG TX
75686-2203
US

V. Phone/Fax

Practice location:
  • Phone: 903-946-5442
  • Fax: 903-946-5258
Mailing address:
  • Phone: 903-946-5519
  • Fax: 903-946-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number438
License Number StateTX

VIII. Authorized Official

Name: MR. W PERRY HENDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-856-4501