East Texas Medical Center Jacksonville

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

000416 Issued in TX

Legal business name

EAST TEXAS MEDICAL CENTER JACKSONVILLE

Practice address

501 S Ragsdale St
Jacksonville, TX 75766-2467

Phone

(903) 541-5000

Fax

(903) 541-5067

NPI assigned

May 22, 2006

Last updated

Dec 2, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jack R Endres

Title

Administrator

Phone

(903) 541-5000

Specialties & licenses 1

Addresses

Other identifiers 8

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Edward Field, M.D.

  • Obstetrics & Gynecology Physician
  • Bryan, TX
  • NPI 1457452195
  NPD (past)

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1285689133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S RAGSDALE ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662467",
            "telephone_number": "903-541-5000",
            "fax_number": "903-541-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S RAGSDALE ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662467",
            "telephone_number": "903-541-5000",
            "fax_number": "903-541-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "ENDRES",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-541-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "000416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130612801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "00J11A",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DBA ETMC FIRST PHYSICIANS CLINIC RUSK",
            "identifier": "1972827822",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "HH0170",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130612806",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130612804",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201848301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DBA ETMC FIRST PHYSICIANS CLINIC FRANKSTON",
            "identifier": "1023342755",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Callie Elizabeth Dunkerson, MS, RD, LD
• Mikayle Anne Durant, APRN
• Ryan Earle, NP
• East Texas Eye Care Associates PLLC (The Optical Shop)
• East Texas Medical Center Healthcare Associates (First Physicians)
• East Texas Medical Center Jacksonville (ETMC First Physicians Clinic Jacksonville)
• Ruth S Eckenrod, PTA
• Edge Medical Supply, LLC
• Eirah Elmer, LPC-S
• Kenya Sekoni Etim, M.D.

• General Acute Care Hospital in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• General Acute Care Hospital in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; 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.