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General NPI Number Information
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NPI Number | 1093186249
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Entity Type | Organization
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Legal Business Name | EAST TEXAS BORDER HEALTH CLINIC
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1205 E 35TH ST
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City | TEXARKANA
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State | AR
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Zip | 71854-2746
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Country | US
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Telephone | 870-216-0080
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Fax | 870-216-0093
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Provider Business Mailing Address
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Address Line | PO BOX 1326
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City | MARSHALL
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State | TX
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Zip | 75671-1326
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Country | US
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Telephone | 903-927-3782
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Fax | 903-927-1764
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Authorized Official
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Title or Position | CEO
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Name | CARLA ROADCAP
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Credential |
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Telephone | 903-927-3782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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