East Texas Out-Patient PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EAST TEXAS OUT-PATIENT PLLC

Practice address

116 N Houston St
Edgewood, TX 75117-1555

Phone

(903) 962-3419

Fax

(903) 385-3340

NPI assigned

Apr 24, 2019

Last updated

Jul 1, 2025By 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

Jimmy W DaileyNPI 1073598199

Title

Owner

Phone

(903) 567-1910

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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.

• Jimmy W Dailey, MD

  • Family Medicine Physician
  • Canton, TX
  • NPI 1073598199
  Medicare reassignment NPD Authorized official
• Muhammad Ali Siddiqui, M.D.

  • Family Medicine Physician
  • Plano, TX
  • NPI 1437125481
  NPD (past)
• Melissa Williams, NP

  • Family Nurse Practitioner
  • Canton, TX
  • NPI 1124595087
  NPD (past)

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1417511593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 76",
            "city": "CANTON",
            "state": "TX",
            "postal_code": "751030076",
            "telephone_number": "903-962-3419",
            "fax_number": "903-962-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 N HOUSTON ST",
            "city": "EDGEWOOD",
            "state": "TX",
            "postal_code": "751171555",
            "telephone_number": "903-962-3419",
            "fax_number": "903-385-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS OUT-PATIENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-24",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "DAILEY",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-567-1910"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bulldog Pharmacy, LLC
• Thomas Chapmond, LCDC
• Yvonne Carol Dixon, LVN
• Tiffany Dunn, MS,CCC/SLP
• East Texas Pediatric Therapy
• Edgewood Drug Inc (Edgewood Legend Drug)
• Edgewood Isd
• Edgewood Rural Healthh Clinic
• Gober LLC (East Texas Pediatric Therapy)

• Family Medicine Physician in Edgewood, TX
• Providers in Edgewood, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.