NPIMap

Organization Active NPI

East Texas Medical Center Specialty Hospital

  • Long Term Care Hospital
  • Tyler, TX
National Provider Identifier
1619092780
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
000777 Issued in TX
Legal business name
EAST TEXAS MEDICAL CENTER SPECIALTY HOSPITAL
Doing business as
East Texas Medical Center Specialty Hospital
Practice address
1000 S Beckham Ave
5TH Floor
Tyler, TX 75701-1908
Phone
(903) 596-3258
Fax
(903) 596-3006
NPI assigned
Mar 20, 2007
Last updated
Sep 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Authorized official

Name
Mr. Eddie L Howard
Title
VP-Coo
Phone
(903) 596-3258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 000777 TX Primary

Addresses

Primary practice location

1000 S Beckham Ave
5TH Floor
Tyler, TX 75701-1908

Mailing address

701 Olympic Plaza Cir
Administration
Tyler, TX 75701-1950
Phone (903) 596-3258

Other identifiers 1

IdentifierTypeStateIssuer
020812603MedicaidTX

Other names 1

  • East Texas Medical Center Specialty Hospital Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1619092780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 OLYMPIC PLAZA CIR",
            "address_2": "ADMINISTRATION",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011950",
            "telephone_number": "903-596-3258",
            "fax_number": "903-596-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BECKHAM AVE",
            "address_2": "5TH FLOOR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011908",
            "telephone_number": "903-596-3258",
            "fax_number": "903-596-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER SPECIALTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP-COO",
        "authorized_official_telephone_number": "903-596-3258",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "TX",
            "license": "000777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020812603",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Texas Medical Center Specialty Hospital",
            "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 Sep 23, 2010; 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.