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NPI Code Detail

MEDICARE: EAST TEXAS COMMUNITY HEALTH SERVICES, INC.

MEDICARE: EAST TEXAS COMMUNITY HEALTH SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician
2207Q00000XFamily Medicine Physician
3261QA0005XAmbulatory Family Planning Facility
4261QM1300XMulti-Specialty Clinic/Center
5363LF0000XFamily Nurse Practitioner
6207V00000XObstetrics & Gynecology Physician
7101YP2500XProfessional Counselor
8261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1255367090
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS COMMUNITY HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : PO BOX 632040
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2040
Country : US
Telephone Number : 936-560-5413
Fax Number : 936-552-7240
Provider Business Practice Location Address
First Line : 1309 S UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-6486
Country : US
Telephone Number : 936-560-5668
Fax Number : 936-552-7240
Authorized Official
Title or Position : CFO
Name : ANITA K HUMPHREYS
Credential :
Telephone Number : 936-560-5413
Provider Enumeration Date : 06/23/2006
Last Update Date : 01/06/2026

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Directions to “EAST TEXAS COMMUNITY HEALTH SERVICES, INC. ” Practice Location

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