NPIMap

Organization Active NPI

East Texas Border Health Clinic

  • Family Medicine Physician
  • Atlanta, TX
National Provider Identifier
1194332155
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAST TEXAS BORDER HEALTH CLINIC
Practice address
1011 S William St
Atlanta, TX 75551-3245
Phone
(903) 796-2868
Fax
(903) 796-0802
NPI assigned
Sep 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Ambulatory Family Planning Facility 261QA0005X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1011 S William St
Atlanta, TX 75551-3245

Mailing address

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

Other practice location 1

805 Lindsey Dr
Marshall, TX 75670-5271
Phone (903) 938-1146

Other practice location 2

622 S Grove St
Marshall, TX 75670-5251
Phone (903) 702-7900

Other practice location 3

620 S Grove St Ste 105
Marshall, TX 75670-5295
Phone (903) 935-9441

Other practice location 4

618 S Grove St Ste 100&300
Marshall, TX 75670-5294
Phone (903) 927-6620

Other practice location 5

1400 College Dr
Texarkana, TX 75503-3536
Phone (903) 791-1110

Other practice location 6

1411 College Dr
Texarkana, TX 75503-3533
Phone (903) 791-1110

Other practice location 7

705 S Grove St
Marshall, TX 75670-5220
Phone (903) 472-7307

Other practice location 8

1205 E 35th St
Texarkana, AR 71854-2746
Phone (870) 216-0080

Other names 1

  • GENESIS PRIME CARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050511001030 TX Part B Supplier - Clinic/Group Practice 8820038565 Receives reassigned benefits from 50 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshall, TX; Texarkana, TX; Atlanta, TX

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

Locations

705 S Grove St
Marshall, TX 75670
Phone (903) 472-7307

618 S Grove St
Ste 100300
Marshall, TX 75670
Phone (903) 927-6620

1411 College Dr
Texarkana, TX 75503
Phone (903) 791-1110

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1194332155",
    "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": "1011 S WILLIAM ST",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755513245",
            "telephone_number": "903-796-2868",
            "fax_number": "903-796-0802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Lindsey Dr",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705271",
            "country_code": "US",
            "telephone_number": "903-938-1146",
            "fax_number": "903-927-2434",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "622 S Grove St",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705251",
            "country_code": "US",
            "telephone_number": "903-702-7900",
            "fax_number": "903-702-7904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "620 S Grove St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705295",
            "country_code": "US",
            "telephone_number": "903-935-9441",
            "fax_number": "903-938-1246",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "618 S Grove St Ste 100&300",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705294",
            "country_code": "US",
            "telephone_number": "903-927-6620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 College Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755033536",
            "country_code": "US",
            "telephone_number": "903-791-1110",
            "fax_number": "903-791-9353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1411 College Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755033533",
            "country_code": "US",
            "telephone_number": "903-791-1110",
            "fax_number": "903-794-2979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 S Grove St",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705220",
            "country_code": "US",
            "telephone_number": "903-472-7307",
            "fax_number": "903-472-7309",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1205 E 35th St",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "AR",
            "postal_code": "718542746",
            "country_code": "US",
            "telephone_number": "870-216-0080",
            "fax_number": "870-216-0093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST TEXAS BORDER HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "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": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GENESIS PRIME CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GENESIS PRIME CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.