NPIMap

Organization Active NPI

East Texas Medical Center Henderson

Doing business as ETMC Henderson FHC

  • Rural Health Clinic/Center
  • Henderson, TX
National Provider Identifier
1376777649
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EAST TEXAS MEDICAL CENTER HENDERSON
Doing business as
ETMC Henderson FHC
Practice address
300 Wilson St
Henderson, TX 75652-5956
Phone
(903) 657-7541
Fax
(903) 657-4009
NPI assigned
May 14, 2009
Last updated
Jan 31, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST TEXAS MEDICAL CENTER HENDERSONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2011

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

Authorized official

Name
Mr. Mark S Leitner
Title
Administrator
Phone
(903) 655-3616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X TX Primary

Addresses

Primary practice location

300 Wilson St
Henderson, TX 75652-5956

Mailing address

300 Wilson St
Henderson, TX 75652-5956
Phone (903) 657-7541

Other identifiers 2

IdentifierTypeStateIssuer
0047SPOtherTXBLUE CROSS BLUE SHIELD
208755301MedicaidTX

Other names 1

  • ETMC Henderson FHC Doing business as

National Provider Directory

National Provider Directory
Part of
East Texas Medical Center Henderson

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1376777649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WILSON ST",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "756525956",
            "telephone_number": "903-657-7541",
            "fax_number": "903-657-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WILSON ST",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "756525956",
            "telephone_number": "903-657-7541",
            "fax_number": "903-657-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER HENDERSON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TEXAS MEDICAL CENTER HENDERSON",
        "enumeration_date": "2009-05-14",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "LEITNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-655-3616",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0047SP",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208755301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC Henderson FHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; 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.