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 Mineola

Practice address

1220 N Pacific St
Mineola, TX 75773-1054

Phone

(903) 569-6124

Fax

(903) 569-2467

NPI assigned

Jul 30, 2006

Last updated

Aug 17, 2016By 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. Warren Robicheaux

Title

Regional Administration

Phone

(903) 946-5500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ETMC First Physicians Clinic Mineola Doing business as

Locations

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1508871278",
    "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": "903-946-5519",
            "fax_number": "903-946-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 N PACIFIC ST",
            "city": "MINEOLA",
            "state": "TX",
            "postal_code": "757731054",
            "telephone_number": "903-569-6124",
            "fax_number": "903-569-2467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER QUITMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "ROBICHEAUX",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "REGIONAL ADMINISTRATION",
        "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": "063351301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017624001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC First Physicians Clinic Mineola",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CVS Pharmacy Inc (CVS Pharmacy #10340)
• Henry Clay Davis, LICENSED PROFESSIONA
• Dehaven Optical Center
• Diana Bankhead MD PLLC
• East Texas Counseling & Family Therapy
• East Texas Medical Center Quitman (ETMC First Physicians Clinic Mineola 2)
• East Texas Rayon Services, LLC
• Elliott-Thomas Health Center PC
• Robert M Elliott, M.D.
• Kathleen Ellsworth

• Rural Health Clinic/Center in Mineola, TX
• Providers in Mineola, 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 17, 2016; 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.