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NPI Code Detail

MEDICARE: EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES

MEDICARE: EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
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
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326082892
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 8659
Second Line :
City : TYLER
State : TX
Zip : 75711-8659
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6210 S BROADWAY AVE
Second Line :
City : TYLER
State : TX
Zip : 75703-4413
Country : US
Telephone Number : 903-579-2800
Fax Number : 903-579-2827
Authorized Official
Title or Position : VP
Name : REBECCA MANGUM
Credential :
Telephone Number : 903-595-3594
Provider Enumeration Date : 06/15/2006
Last Update Date : 04/11/2017

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Directions to “EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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