MEDICARE: EAST TEXAS MEDICAL CENTER PITTSBURG

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	251E00000X	Home Health Agency	001731	TX

General Provider Information

NPI Number	:	1730188822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST TEXAS MEDICAL CENTER PITTSBURG

Provider Business Mailing Address
First Line	:	208 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1630
Country	:	US
Telephone Number	:	903-856-6554
Fax Number	:	903-856-0084

Provider Business Practice Location Address
First Line	:	208 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1630
Country	:	US
Telephone Number	:	903-856-6554
Fax Number	:	903-856-0084

Authorized Official
Title or Position	:	AREA DIRECTOR OF OPERATIONS
Name	:	MS. TRACI K. ANDERSON
Credential	:
Telephone Number	:	903-535-6056

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/22/2020

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