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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1346560224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 9477
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75711-9477
Country	:	US
Telephone Number	:	903-594-2497
Fax Number	:	903-939-0610

Provider Business Practice Location Address
First Line	:	612 N HIGH ST STE A
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75652-5914
Country	:	US
Telephone Number	:	903-594-2497
Fax Number	:	903-939-0610

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. KIM PEARSON-WAHL
Credential	:
Telephone Number	:	903-535-6890

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	07/22/2010

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