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General NPI Number Information
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NPI Number | 1326596776
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CLINICAL SERVICES INC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 9201 PINECROFT DR
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City | SHENANDOAH
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State | TX
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Zip | 77380-3222
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Country | US
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Telephone | 832-246-8000
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Fax | 832-246-8100
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Provider Business Mailing Address
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Address Line | 6624 FANNIN ST SUITE 2500
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City | HOUSTON
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State | TX
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Zip | 77030-2312
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Country | US
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Telephone | 832-355-3403
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MATTHEW C WRIGHT
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Credential |
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Telephone | 214-213-1152
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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 |
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License Number State | TX
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