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General NPI Number Information
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NPI Number | 1023342755
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Entity Type | Organization
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Legal Business Name | EAST TEXAS MEDICAL CENTER JACKSONVILLE
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 580 NORTH FRANKSTON HIGHWAY
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City | FRANKSTON
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State | TX
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Zip | 75763-2654
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Country | US
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Telephone | 903-876-5888
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Fax | 903-876-5889
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Provider Business Mailing Address
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Address Line | 501 S RAGSDALE ST
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2434
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Country | US
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Telephone | 903-541-5100
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Fax | 903-541-5068
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JACK R ENDRES
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Credential |
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Telephone | 903-541-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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