East Texas Medical Center Athens

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

000374 Issued in TX

Legal business name

EAST TEXAS MEDICAL CENTER ATHENS

Practice address

2000 S Palestine St
Athens, TX 75751-5610

Phone

(903) 675-2216

NPI assigned

Jan 12, 2006

Last updated

Dec 5, 2013By 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. Pat Wallace

Title

Administator

Phone

(903) 675-1000

Specialties & licenses 3

Addresses

Other identifiers 6

Locations

Practitioners 2

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.

• Danny Fillip, PA-C

  • Physician Assistant
  • Tyler, TX
  • NPI 1992745053
  NPD (past)
• John C Blaney, M.D.

  • Surgery Physician
  • Templeton, CA
  • NPI 1063594059
  NPD (past)

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1356320873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1996",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757511996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S PALESTINE ST",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757515610",
            "telephone_number": "903-675-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER ATHENS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "PAT",
        "authorized_official_title_or_position": "ADMINISTATOR",
        "authorized_official_telephone_number": "903-675-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "000374",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "000374",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "000374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139713209",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "HH0406",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139173213",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0088DQ",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139173207",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139173211",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Texas Community Clinic, Inc.
• East Texas Community Clinic, Inc. (East Texas Community Clinic Pharmacy)
• East Texas Eye Care Associates, PLLC (The Optical Shop)
• East Texas Family Guidance Center
• East Texas Home Health Services LLC (UT Health East Texas Home Health Services)
• East Texas Medical Center Healthcare Associates (First Physicians)
• East Texas Medical Center Home Services (ETMC Home Health - West)
• East Texas Medical Imaging
• East Texas Pathology Laboratories
• East Texas Psychological Services, PLLC

• General Acute Care Hospital in Athens, TX
• Providers in Athens, 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 5, 2013; 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.