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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
1208600000XSurgery Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CE9194OTHERTXRAILROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396773339
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 131027
Second Line :
City : TYLER
State : TX
Zip : 75713-1027
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1020 E IDEL ST
Second Line :
City : TYLER
State : TX
Zip : 75701-2024
Country : US
Telephone Number : 903-596-3555
Fax Number : 903-596-3560
Authorized Official
Title or Position : VP
Name : REBECCA MANGUM
Credential :
Telephone Number : 903-596-3594
Provider Enumeration Date : 06/29/2006
Last Update Date : 04/11/2017

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1528234721 — EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
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Practice Fax: 903-939-0610
1386993392 — JENNIFER ROBB ACNP
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1962838698 — KARLA TIMMS NP
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1053785568 — MISS NATALIE SHEA WILLIAMS PA-C
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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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