NPIMap

Organization Active NPI

East Texas Medical Center Healthcare Associates

Doing business as East Texas Medical Center Trauma Services

  • Surgery Physician
  • Tyler, TX
National Provider Identifier
1396773339
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Doing business as
East Texas Medical Center Trauma Services
Practice address
1020 E Idel St
Tyler, TX 75701-2024
Phone
(903) 596-3555
Fax
(903) 596-3560
NPI assigned
Jun 29, 2006
Last updated
Apr 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Authorized official

Name
Rebecca Mangum
Title
VP
Phone
(903) 596-3594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

1020 E Idel St
Tyler, TX 75701-2024

Mailing address

PO Box 131027
Tyler, TX 75713-1027

Other identifiers 2

IdentifierTypeStateIssuer
084245201MedicaidTX
CE9194OtherTXRAILROAD MEDICARE PIN

Other names 1

  • East Texas Medical Center Trauma Services Doing business as

National Provider Directory

National Provider Directory

Locations

1020 E Idel St
Tyler, TX 75701
Phone (903) 535-2902

2737 S Broadway Ave
Ste 100
Tyler, TX 75701
Phone (903) 597-8719

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1396773339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 131027",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757131027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 E IDEL ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012024",
            "telephone_number": "903-596-3555",
            "fax_number": "903-596-3560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "903-596-3594"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084245201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CE9194",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Texas Medical Center Trauma Services",
            "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 Apr 11, 2017; 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.