Healthcare Provider Details

I. General information

NPI: 1235256884
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

V. Phone/Fax

Practice location:
  • Phone: 903-531-8170
  • Fax: 903-535-6102
Mailing address:
  • Phone: 903-531-8170
  • Fax: 903-535-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. BYRON HALE
Title or Position: SENIOR VICE PRESIDENT FINANCE
Credential:
Phone: 903-531-8010