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General NPI Number Information
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NPI Number | 1356320873
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Entity Type | Organization
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Legal Business Name | EAST TEXAS MEDICAL CENTER ATHENS
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 2000 S PALESTINE ST
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City | ATHENS
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State | TX
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Zip | 75751-5610
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Country | US
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Telephone | 903-675-2216
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1996
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City | ATHENS
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State | TX
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Zip | 75751-1996
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTATOR
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Name | MR. PAT WALLACE
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Credential |
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Telephone | 903-675-1000
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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 | 000374
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 000374
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 000374
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License Number State | TX
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