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General NPI Number Information
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NPI Number | 1194877340
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Entity Type | Organization
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Legal Business Name | EAST TEXAS MEDICAL CENTER PITTSBURG
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 402 S GREER BLVD
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City | PITTSBURG
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State | TX
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Zip | 75686-1700
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Country | US
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Telephone | 903-856-7437
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Fax | 903-856-3067
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Provider Business Mailing Address
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Address Line | 414 QUITMAN ST
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City | PITTSBURG
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State | TX
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Zip | 75686-1032
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Country | US
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Telephone | 903-856-6663
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Fax | 903-856-4531
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. W PERRY HENDERSON
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Credential |
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Telephone | 903-856-4501
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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 | 000438
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License Number State | TX
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