1295719227 NPI number — EAST TEXAS MEDICAL CENTER-GILMER

Table of content: (NPI 1295719227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295719227 NPI number — EAST TEXAS MEDICAL CENTER-GILMER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST TEXAS MEDICAL CENTER-GILMER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295719227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75686-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-946-5519
Provider Business Mailing Address Fax Number:
903-946-5531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 N WOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILMER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75644-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-841-7100
Provider Business Practice Location Address Fax Number:
903-946-5531
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROLSTON
Authorized Official First Name:
TAMBRI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
REGIONAL DIRECTOR OF BUSINESS SER
Authorized Official Telephone Number:
903-946-5500

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  008068 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HH1051 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00C13V . This is a "PHYSICIAN BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 168447403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0069NE . This is a "RHC GROUP BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 168447402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168447401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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