NPIMap

Organization Active NPI

East Texas Medical Center Crockett

  • General Acute Care Hospital
  • Crockett, TX
National Provider Identifier
1073500799
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
000185 Issued in TX
Legal business name
EAST TEXAS MEDICAL CENTER CROCKETT
Doing business as
ETMC Crockett
Practice address
1100 E Loop 304
Crockett, TX 75835-1810
Phone
(936) 546-3803
Fax
(936) 546-3816
NPI assigned
Sep 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Stacy Bailey Dise
Title
Business Office Manager
Phone
(936) 546-3810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 000185 TX Primary

Addresses

Primary practice location

1100 E Loop 304
Crockett, TX 75835-1810

Mailing address

PO Box 1129
Crockett, TX 75835-1129
Phone (936) 546-3862

Other names 1

  • ETMC Crockett Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073500799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1129",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351129",
            "telephone_number": "936-546-3862",
            "fax_number": "936-546-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-546-3803",
            "fax_number": "936-546-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER CROCKETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DISE",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "BAILEY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "936-546-3810",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "000185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC Crockett",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crockett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.