NPIMap

Organization Active NPI

East Texas Medical Center Crockett

  • Ambulatory Surgical Clinic/Center
  • Crockett, TX
National Provider Identifier
1619941291
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EAST TEXAS MEDICAL CENTER CROCKETT
Practice address
1100 E Loop 304
Crockett, TX 75835-1810
Phone
(936) 546-3862
Fax
(936) 546-3816
NPI assigned
Feb 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Stacy Bailey Dise
Title
Business Office Director
Phone
(936) 546-3810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1100 E Loop 304
Crockett, TX 75835-1810

Mailing address

PO Box 1129
Crockett, TX 75835-1129
Phone (936) 546-3849

National Provider Directory

National Provider Directory
Tax ID family
East Texas Medical Center Crockett5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619941291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1129",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351129",
            "telephone_number": "936-546-3849",
            "fax_number": "936-546-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-546-3862",
            "fax_number": "936-546-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER CROCKETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DISE",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "BAILEY",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "936-546-3810",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crockett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.