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General NPI Number Information
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NPI Number | 1518015908
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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 | 01/08/2007
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 2701 U.S. HWY 271 N
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City | PITTSBURG
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State | TX
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Zip | 75686-4289
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Country | US
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Telephone | 903-946-5442
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Fax | 903-946-5258
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Provider Business Mailing Address
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Address Line | PO BOX 1304
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City | PITTSBURG
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State | TX
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Zip | 75686-2203
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Country | US
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Telephone | 903-946-5519
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Fax | 903-946-5531
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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 | 438
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License Number State | TX
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