East Texas Border Health Clinic
Organization Active NPI Federally Qualified Health Center (FQHC) · Marshall, TX
NPI 1023630969 · NPPES record last updated Aug 28, 2023
Key facts
- NPI
- 1023630969
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- EAST TEXAS BORDER HEALTH CLINIC
- Practice address
- 622 S Grove St
Marshall, TX 75670-5251 - Phone
- (903) 702-7900
- Fax
- (903) 702-7904
- NPI assigned
- May 14, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- EAST TEXAS BORDER HEALTH CLINIC
Authorized official
- Name
- Carla Roadcap
- Title
- Ceo
- Phone
- (903) 927-3782
Owners & managing parties with NPI records 2
-
Valarie L. Allman, M.D.
-
Jeffory W Beaty, DO
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 10
Practitioners 69
-
Jared Dale Clark, APN
-
Ricky Allen Paul, MD
-
Danette Allen, LCSW
-
Mary S Anderson, MD
-
Cheyanne Autry, APRN, FNP-C
-
Jeffory W Beaty, DO
-
Stephanie Bradley, FNP-C
-
Stephen K Erlewine, FNP
-
Melinda Fenton, APRN, PMHNP-BC
-
Ashley Gaddy, DNP, APRN, FNP-BC
-
Almer Lee Hadaway Jr., RN, FNP-C, RRT, RNFA
-
Deborah James, LCDC, LPC
-
Nita Ann Little, FNP
-
Veronica McCoy, R.N, M.S.N., C.F.N.P
-
Tiffany A McFarland, LCSW
-
Amy E Miller, LPC
-
Tirsa Elaine Miller, FNP
-
Antoinette R Riley, FNP, DCNP
-
Jennifer A Robinson, APRN, PMHNP-BC
-
Terri A Rowe, LMSW
-
Rikki Dawn Sandvik, WHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 451112
- Legal name
- EAST TEXAS BORDER HEALTH CLINIC
- Doing business as
- GENESIS PRIMECARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 20, 2020
- Last certification
- May 20, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 15, 2004 in TX
- Enrollment address
- 622 S Grove St
Marshall, TX 75670-5251
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Deborah Moore |
Corporate Director |
Nov 21, 2013 | |
| Rondal Gary Nutter |
Corporate Director |
May 29, 2014 | |
| Kimberly Quiett |
Corporate Director |
Oct 27, 2016 | |
| Carla Roadcap |
Corporate Officer |
May 1, 2014 | |
| W-2 Managing Employee |
May 1, 2014 | ||
| Alana Higgins |
Corporate Director |
Jul 29, 2021 | |
| Marva Simpson |
Corporate Director |
Feb 22, 2018 | |
| Michael G Boles |
Corporate Director |
Dec 20, 2012 | |
| Jeffory W Beaty |
Corporate Officer |
Apr 12, 2012 | |
| Amanda Abraham |
Corporate Director |
Feb 27, 2025 | |
| Betty Yarber |
Corporate Director |
Feb 27, 2025 | |
| Ted David Huffhines |
Corporate Director |
Aug 25, 2022 | |
| Glenn Bickerdike |
Corporate Director |
Mar 31, 2025 | |
| Ruthie Smith |
Corporate Director |
Jun 20, 2018 | |
| Julie Stowe |
Corporate Officer |
Jan 23, 2013 | |
| Stuart Smith |
Corporate Director |
Oct 27, 2016 | |
| Valarie a Allman |
Corporate Director | Aug 25, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050511001030 | TX | Part B Supplier - Clinic/Group Practice | 8820038565 |
Receives reassigned benefits from 50 practitioners 17 other NPIs on this enrollment Practice locations: Marshall, TX; Texarkana, TX; Atlanta, TX |
| O20200605000997 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 8820038565 | Practice locations: Marshall, TX |
National Provider Directory
- Part of
- East TX Border HLTH Clin
Locations
620 S Grove St
Ste 105
Marshall, TX 75670
Phone (903) 935-9441
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
622 S Grove St
Marshall, TX 75670-5251
Mailing address
PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782
Other providers in Marshall, TX
- Dudley Consulting & Coaching Services, LLC.
- Crystal Dionne Dudley
- Janice Larue Dudley
- Douglas E Duncan
- East Texas Babtist University
- East Texas Border Health Clinic
- East Texas Border Health Clinic
- East Texas Border Health Clinic
- East Texas Border Health Clinic
- East Texas Border Health Clinic
All providers in Marshall, TX · Federally Qualified Health Center (FQHC) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.