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NPI Code Detail

MEDICARE: EAST TEXAS BORDER HEALTH CLINIC

MEDICARE: EAST TEXAS BORDER HEALTH CLINIC
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
1101Y00000XCounselor
2104100000XSocial Worker
3207Q00000XFamily Medicine Physician
4207V00000XObstetrics & Gynecology Physician
5208000000XPediatrics Physician
6261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1548745383
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS BORDER HEALTH CLINIC
Provider Business Mailing Address
First Line : PO BOX 1326
Second Line :
City : MARSHALL
State : TX
Zip : 75671-1326
Country : US
Telephone Number : 903-927-3782
Fax Number :
Provider Business Practice Location Address
First Line : 4077 JEFFERSON AVE
Second Line :
City : TEXARKANA
State : AR
Zip : 71854-1509
Country : US
Telephone Number : 903-614-5270
Fax Number :
Authorized Official
Title or Position : CEO
Name : CARLA ROADCAP
Credential :
Telephone Number : 903-927-3782
Provider Enumeration Date : 09/27/2018
Last Update Date : 08/28/2023

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Directions to “EAST TEXAS BORDER HEALTH CLINIC ” Practice Location

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