East Texas Medical Center Quitman

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

EAST TEXAS MEDICAL CENTER QUITMAN

Doing business as

ETMC First Physicians Clinic Quitman

Practice address

117 N Winnsboro St
Quitman, TX 75783-2144

Phone

(903) 763-6220

Fax

(903) 946-5531

NPI assigned

Jul 30, 2006

Last updated

Aug 6, 2014By 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. William P Henderson

Title

VP Affiliate Operations

Phone

(903) 946-5500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ETMC First Physicians Clinic Quitman Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

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

• Quitman Hospital LLC

  • Rural Health Clinic/Center
  • Quitman, TX
  • NPI 1306345764

  Sold to, 2018-03-01

  CMS change of ownership

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1508871245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1304",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756862203",
            "telephone_number": "903-763-6220",
            "fax_number": "903-946-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N WINNSBORO ST",
            "city": "QUITMAN",
            "state": "TX",
            "postal_code": "757832144",
            "telephone_number": "903-763-6220",
            "fax_number": "903-946-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER QUITMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP AFFILIATE OPERATIONS",
        "authorized_official_telephone_number": "903-946-5500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172427001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172427002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC First Physicians Clinic Quitman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paula Jean Dibenedetto, ARNP
• James Dee Dopson Jr., MD
• East Texas Medical Center
• East Texas Medical Center Healthcare Associates (First Physicians)
• East Texas Medical Center Quitman
• East Texas Optical, Inc
• Gregory S Eberhart, D.D.S.
• Rolando Fabian, COTA
• Family Care Center Quitman
• Christian Ferrer, MD

• Rural Health Clinic/Center in Quitman, TX
• Providers in Quitman, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.