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General NPI Number Information
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NPI Number | 1265554000
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CHEST CLINIC, P.A.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 818 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3317
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Country | US
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Telephone | 936-639-6210
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Fax | 936-639-2298
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Provider Business Mailing Address
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Address Line | 818 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3317
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Country | US
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Telephone | 936-639-6210
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Fax | 936-639-2298
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Authorized Official
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Title or Position | ,OFFICE MANAGER
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Name | SUSIE L. CLARK
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Credential |
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Telephone | 936-639-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G4729
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License Number State | TX
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