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General NPI Number Information
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NPI Number | 1548358351
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Entity Type | Organization
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Legal Business Name | MEMORIAL HEALTH SYSTEM OF EAST TEXAS
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 1109 ELLIS AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3346
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Country | US
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Telephone | 936-639-7080
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Fax | 936-639-7576
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Provider Business Mailing Address
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Address Line | PO BOX 1447
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City | LUFKIN
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State | TX
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Zip | 75902-1447
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Country | US
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Telephone | 936-639-7080
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Fax | 936-639-7576
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. PATRICIA JONES
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Credential | RN, BA
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Telephone | 936-639-7083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 016381
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License Number State | TX
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