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General NPI Number Information
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NPI Number | 1497568513
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Entity Type | Organization
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Legal Business Name | EAST TEXAS COMMUNITY CLINIC, INC.
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 400 E STATE HIGHWAY 243 STE 18
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City | CANTON
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State | TX
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Zip | 75103-2445
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Country | US
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Telephone | 903-287-5011
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Fax | 903-802-7125
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Provider Business Mailing Address
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Address Line | PO BOX 1610
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City | ATHENS
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State | TX
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Zip | 75751-1610
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Country | US
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Telephone | 903-603-9851
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Fax | 903-802-7125
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Authorized Official
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Title or Position | CEO
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Name | GLEN W ROBISON
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Credential |
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Telephone | 903-603-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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