NPIMap

Organization Active NPI

Ut East Texas Urgent Care Centers, PLLC

  • Urgent Care Clinic/Center
  • Canton, TX
National Provider Identifier
1356974281
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
UT EAST TEXAS URGENT CARE CENTERS, PLLC
Practice address
301 E State Highway 243 Ste 121
Canton, TX 75103-2418
Phone
(903) 567-4692
NPI assigned
Feb 19, 2020
Last updated
Oct 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Stephen C. Petrovich
Title
Evp, General Counsel
Phone
(615) 296-3594

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

301 E State Highway 243 Ste 121
Canton, TX 75103-2418

Mailing address

340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697
Phone (615) 296-3594

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20200910000672 TX Part B Supplier - Clinic/Group Practice 7517385388 Receives reassigned benefits from 46 practitioners
Practice locations: Canton, TX; Tyler, TX
O20211208002524 TX DME Supplier - Multi-Specialty - Physician 7517385388 Practice locations: Canton, TX
O20240403000290 TX Part A Provider - Rural Health Clinic 7517385388 Practice locations: Kilgore, TX
O20240606002405 TX Part A Provider - Rural Health Clinic 7517385388 Practice locations: Carthage, TX
O20240610002498 TX Part A Provider - Rural Health Clinic 7517385388 Practice locations: Henderson, TX
O20240703003468 TX Part A Provider - Rural Health Clinic 7517385388 Practice locations: Mabank, TX
O20240712000595 TX Part A Provider - Rural Health Clinic 7517385388 Practice locations: Jacksonville, TX

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1356974281. Details of each certification follow.

Rural health clinic certification: CCN 678915

Legal name
UT EAST TEXAS URGENT CARE CENTERS, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 15, 2023
Last certification
Sep 15, 2023
Ownership / control type
1B
Organization structure
OtherProprietary
Enrollment address
1016 N Kilgore St
Kilgore, TX 75662-6054

Rural health clinic certification: CCN 678914

Legal name
UT EAST TEXAS URGENT CARE CENTERS, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 30, 2023
Last certification
Oct 30, 2023
Ownership / control type
1B
Most recent change of ownership
Jan 12, 2024 (1 total)
Organization structure
OtherProprietary
Enrollment address
1301 West Panola Street
Carthage, TX 75633-2345

Rural health clinic certification: CCN 678911

Legal name
UT EAST TEXAS URGENT CARE CENTERS, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 16, 2023
Last certification
Sep 16, 2023
Ownership / control type
1B
Most recent change of ownership
Jan 12, 2024 (1 total)
Organization structure
OtherProprietary
Enrollment address
1600 US Highway 79 S
Henderson, TX 75654-4508

Rural health clinic certification: CCN 678918

Legal name
UT EAST TEXAS URGENT CARE CENTERS, PLLC
Doing business as
UTHEALTH EAST TEXAS PHYSICIANS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 16, 2023
Last certification
Sep 16, 2023
Ownership / control type
1B
Organization structure
OtherProprietary
Enrollment address
1703 S 3Rd St
Mabank, TX 75147-7301

Rural health clinic certification: CCN 678916

Legal name
UT EAST TEXAS URGENT CARE CENTERS, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 16, 2023
Last certification
Sep 16, 2023
Ownership / control type
1B
Most recent change of ownership
Jan 12, 2024 (1 total)
Organization structure
OtherProprietary
Enrollment address
1602 S Jackson St
Jacksonville, TX 75766-3028

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2181446Ut East Texas Urgent Care Centers, PLLC1600 US 79, Ste 1600, Henderson, TX 75654Certificate of waiverApr 2, 2028
45D2193260Ut East Texas Urgent Care Centers, PLLC1602 S Jackson St, Jacksonville, TX 75766Certificate of waiverSep 17, 2026
45D2195079Ut East Texas Urgent Care Centers PLLC301 E State Hwy 243, Ste 121, Canton, TX 75103Certificate of waiverOct 5, 2026
45D2199214Ut East Texas Urgent Care Centers, PLLC1016 North Kilgore Street, Kilgore, TX 75662Certificate of waiverNov 5, 2026
45D2199221Ut East Texas Urgent Care Centers, PLLC1301 West Panola St, Carthage, TX 75633Certificate of waiverNov 5, 2026
45D2234680Ut East Texas Urgent Care Centers, PLLC1703 S Third St, Mabank, TX 75147Certificate of waiverSep 1, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

301 E State Highway 243
Ste 121
Canton, TX 75103
Phone (903) 567-4692

1703 S 3rd St
Mabank, TX 75147
Phone (903) 225-7189

3753 Earl Campbell Pkwy
Tyler, TX 75701
Phone (903) 747-9550

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ardent Health Inc Organization, Brentwood, TN LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
5% Or Greater Indirect Ownership Interest Jul 17, 2024 100%
Ahs Texas, LLC Organization, Brentwood, TN LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
5% Or Greater Indirect Ownership Interest Jan 12, 2024 100%
East Texas Holdings, LLC Organization, Brentwood, TN LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
5% Or Greater Indirect Ownership Interest Jan 1, 2024
5% Or Greater Indirect Ownership Interest Jan 12, 2024 100%
Mary a Crabtree Individual Corporate OfficerSVP, Treasurer Jan 12, 2024
Corporate OfficerSVP Treasurer Jan 12, 2024
Corporate OfficerSVP Treasurer Jan 13, 2024
Etmc Physician Group, Inc. Organization, Brentwood, TN Corporation, Medical provider/supplier, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2024 100%
5% Or Greater Direct Ownership Interest Jan 12, 2024 100%
Stephen C Petrovich Individual Corporate OfficerEvp General Counsel Jan 12, 2024
Corporate OfficerEvp, General Counsel Jan 12, 2024
Corporate OfficerEvp General Counsel Jan 13, 2024
Ardent Legacy Holdings LLC Organization, Brentwood, TN LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
5% Or Greater Indirect Ownership Interest Jan 12, 2024 100%
Ahs East Texas Health System, LLC Organization, Brentwood, TN LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
5% Or Greater Indirect Ownership Interest Jan 12, 2024 100%
Donald Baker Individual Corporate OfficerChief Executive Officer Sep 20, 2021
W-2 Managing EmployeeChief Executive Officer Sep 20, 2021
Corporate OfficerChief Executive Officer Sep 30, 2021 100%
Corporate OfficerChief Executive Officer Sep 20, 2021 100%
W-2 Managing EmployeeChief Executive Officer Jan 1, 2024
Ahp Health Partners, Inc Organization, Brentwood, TN Corporation, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 66

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Athens Hospital, LLC
    • General Acute Care Hospital
    • Athens, TX
    • NPI 1417465824

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Bsa Hospital LLC
    • General Acute Care Hospital
    • Amarillo, TX
    • NPI 1407191984

    Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Bsa Hospital LLC
    • Rehabilitation Hospital Unit
    • Amarillo, TX
    • NPI 1730425190

    Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Carthage Hospital, LLC
    • Rural Health Clinic/Center
    • Carthage, TX
    • NPI 1407355860

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Carthage Hospital, LLC
    • General Acute Care Hospital
    • Carthage, TX
    • NPI 1538667035

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Carthage Hospital, LLC
    • Rural Health Clinic/Center
    • Carthage, TX
    • NPI 1639678030

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • East Texas Home Health Services LLC

    dba UT Health East Texas Home Health Services

    • Home Health Agency
    • Pittsburg, TX
    • NPI 1578061487

    East Texas Holdings, LLC

    CMS ownership
  • East Texas Home Health Services LLC

    dba UT Health East Texas Home Health Services

    • Home Health Agency
    • Athens, TX
    • NPI 1760980668

    East Texas Holdings, LLC

    CMS ownership
  • Encompass Health Rehabilitation Hospital of Amarillo, LLC

    dba Rehabilitation Hospital of Amarillo

    • Rehabilitation Hospital
    • Amarillo, TX
    • NPI 1487443099

    Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Etmc Physician Group Inc.
    • Rural Health Clinic/Center
    • Chandler, TX
    • NPI 1235706581

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC, East Texas Holdings, LLC

    CMS ownership
  • Etmc Physician Group Inc.
    • Rural Health Clinic/Center
    • Gun Barrel City, TX
    • NPI 1689241945

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC, East Texas Holdings, LLC

    CMS ownership
  • FMC - Lubbock LLC

    dba BSA Hospice of the Southwest

    • Community Based Hospice Care Agency
    • Amarillo, TX
    • NPI 1467447854

    Ardent Legacy Holdings LLC

    CMS ownership
View all 66

Change-of-ownership history 4

DateEventCounterparty
Jan 12, 2024 Change of OwnershipThis provider was the buyer Quickvisit Urgent CareCCN 678915, TX, NPI 1437875192
Jan 12, 2024 Change of OwnershipThis provider was the buyer Quickvisit Urgent CareCCN 678914, TX, NPI 1720704471
Jan 12, 2024 Change of OwnershipThis provider was the buyer Quickvisit Urgent CareCCN 678911, TX, NPI 1992421895
Jan 12, 2024 Change of OwnershipThis provider was the buyer Quickvisit Urgent CareCCN 678916, TX, NPI 1881310548

Change of ownership 4

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 50

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.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1356974281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SEVEN SPRINGS WAY STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275697",
            "telephone_number": "615-296-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E STATE HIGHWAY 243 STE 121",
            "city": "CANTON",
            "state": "TX",
            "postal_code": "751032418",
            "telephone_number": "903-567-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UT EAST TEXAS URGENT CARE CENTERS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EVP, GENERAL COUNSEL",
        "authorized_official_telephone_number": "615-296-3594"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, TX

Sources for this page

Verify at the official NPI Registry.