NPIMap

Organization Active NPI

Community Health Clinic of Northeast Texas

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
National Provider Identifier
1265613285
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CLINIC OF NORTHEAST TEXAS
Practice address
928 N Glenwood Blvd
Tyler, TX 75702-5055
Phone
(903) 533-7400
NPI assigned
Nov 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Judy Davis, MBA,MHA
Title
Executive Director
Phone
(903) 533-7404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

928 N Glenwood Blvd
Tyler, TX 75702-5055

Mailing address

815 N Broadway Ave
Tyler, TX 75702-4507
Phone (903) 535-0023

Other names 1

  • ST. PAUL'S MOBILE CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Community Health Clinics of Northeast Texas3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1265613285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757024507",
            "telephone_number": "903-535-0023",
            "fax_number": "903-535-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 N GLENWOOD BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757025055",
            "telephone_number": "903-533-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CLINIC OF NORTHEAST TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "903-533-7404",
        "authorized_official_credential": "MBA,MHA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. PAUL'S MOBILE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.