East Texas Medical Center Clarksville

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

000292 Issued in TX

Legal business name

EAST TEXAS MEDICAL CENTER CLARKSVILLE

Practice address

3000 W Main St
Clarksville, TX 75426-3371

Phone

(903) 632-5632

Fax

(903) 427-2719

NPI assigned

Jul 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tambri L Rolston

Title

Regional Director of Business Ser

Phone

(903) 946-5519

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• ETMC First Physicians Clinic Clarksville Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361836800000",
    "number": "1063447159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1304",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756862203",
            "telephone_number": "903-427-6400",
            "fax_number": "903-427-2719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 W MAIN ST",
            "city": "CLARKSVILLE",
            "state": "TX",
            "postal_code": "754263371",
            "telephone_number": "903-632-5632",
            "fax_number": "903-427-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER CLARKSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2013-02-26",
        "status": "A",
        "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": "903-946-5519",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "000292",
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "TX",
            "license": "000292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063513801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017887301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC First Physicians Clinic Clarksville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Core Health Systems
• Country Home Care, Inc.
• CVS Pharmacy Inc
• Daily Medical Supply, Inc.
• Detroit I.S.D.
• East Texas Medical Center Clarksville
• East Texas Medical Center Clarksville
• East Texas Medical Center-Clarksville
• Devabrata Ganguly, M.D.
• Brittany Kaye Graham, FNP-C

• Rural Health Clinic/Center in Clarksville, TX
• Providers in Clarksville, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.