Healthcare Provider Details

I. General information

NPI: 1508871245
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER QUITMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N WINNSBORO ST
QUITMAN TX
75783-2144
US

IV. Provider business mailing address

PO BOX 1304
PITTSBURG TX
75686-2203
US

V. Phone/Fax

Practice location:
  • Phone: 903-763-6220
  • Fax: 903-946-5531
Mailing address:
  • Phone: 903-763-6220
  • Fax: 903-946-5531

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: VP AFFILIATE OPERATIONS
Credential:
Phone: 903-946-5500