NPIMap

Organization Active NPI

East Texas Border Health Clinic

Doing business as Genesis PrimeCare

  • Federally Qualified Health Center (FQHC)
  • Texarkana, TX
National Provider Identifier
1104361781
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST TEXAS BORDER HEALTH CLINIC
Doing business as
Genesis PrimeCare
Practice address
1400 College Dr
Texarkana, TX 75503-3536
Phone
(903) 791-1110
Fax
(903) 791-9353
NPI assigned
Jan 5, 2017
Last updated
Aug 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST TEXAS BORDER HEALTH CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Carla Roadcap
Title
Ceo
Phone
(903) 927-3782

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Dentist 122300000X NU
General Practice Dentistry 1223G0001X NU

Addresses

Primary practice location

1400 College Dr
Texarkana, TX 75503-3536

Mailing address

PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782

Other names 1

  • Genesis PrimeCare Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sabine Valley Center PR8 organizations share this tax ID, including this one
Part of
Sabine Valley Center PR

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1400 College Dr
Ste 204
Texarkana, TX 75503
Phone (903) 791-1110

NPI Registry JSON

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1104361781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1326",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756711326",
            "telephone_number": "903-927-3782",
            "fax_number": "903-927-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COLLEGE DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033536",
            "telephone_number": "903-791-1110",
            "fax_number": "903-791-9353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS BORDER HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TEXAS BORDER HEALTH CLINIC",
        "enumeration_date": "2017-01-05",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "ROADCAP",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-927-3782"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis PrimeCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genesis PrimeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.