NPIMap

Organization Active NPI

East Texas Border Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Marshall, TX
National Provider Identifier
1588092472
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST TEXAS BORDER HEALTH CLINIC
Practice address
401 N Grove Street
Marshall, TX 75670-3255
Phone
(903) 665-8453
Fax
(903) 665-8496
NPI assigned
Oct 31, 2013
Organization subpart
Yes
Parent organization
EAST TEXAS BORDER HEALTH CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Carla Roadcap
Title
Chief Executive Officer
Phone
(903) 927-3782

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

401 N Grove Street
Marshall, TX 75670-3255

Mailing address

PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782

Other names 1

  • Genesis PrimeCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050511001030 TX Part B Supplier - Clinic/Group Practice 8820038565 Receives reassigned benefits from 50 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshall, TX; Texarkana, TX; Atlanta, TX

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Part of
East TX Border HLTH Clin

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1383177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1588092472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1326",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756711326",
            "telephone_number": "903-927-3782",
            "fax_number": "903-472-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N GROVE STREET",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756703255",
            "telephone_number": "903-665-8453",
            "fax_number": "903-665-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS BORDER HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TEXAS BORDER HEALTH CLINIC",
        "enumeration_date": "2013-10-31",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "ROADCAP",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "903-927-3782"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis PrimeCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genesis PrimeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.