NPIMap

Organization Active NPI

East Texas Family Healthcare PLLC

  • Rural Health Clinic/Center
  • Kirbyville, TX
National Provider Identifier
1629087630
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
673880 Issued in TX
Legal business name
EAST TEXAS FAMILY HEALTHCARE PLLC
Practice address
1905 N Margaret Ave
Kirbyville, TX 75956-1652
Phone
(409) 420-0816
Fax
(409) 420-0821
NPI assigned
Aug 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Authorized official

Name
Kalyan K Rath, MDNPI 1639188147
Title
Owner
Phone
(409) 384-9200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 673880 TX Primary

Addresses

Primary practice location

1905 N Margaret Ave
Kirbyville, TX 75956-1652

Mailing address

1905 N Margaret Ave
Kirbyville, TX 75956-1652
Phone (409) 420-0816

Other identifiers 1

IdentifierTypeStateIssuer
161594003MedicaidTX

Other names 1

  • Family Healthcare- Kirbyville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041028000741 TX Part A Provider - Rural Health Clinic 2961310610 Practice locations: Kirbyville, TX

Rural health clinic certification: CCN 673880

Legal name
EAST TEXAS FAMILY HEALTHCARE PLLC
Doing business as
FAMILY HEALTHCARE-KIRBYVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 23, 2005
Last certification
Mar 13, 2018
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
1905 N Margaret Ave
Family Healthcare-Kirbyville
Kirbyville, TX 75956-1652

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1031600Family Healthcare-Kirbyville1905 N Margaret, Kirbyville, TX 75956Certificate of waiverOct 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
East Texas Family Healthcare PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kalyan K Rath Individual 5% Or Greater Direct Ownership Interest Oct 27, 2004
W-2 Managing Employee Oct 27, 2004
Tracy Butters Individual W-2 Managing Employee Feb 8, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1629087630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 N MARGARET AVE",
            "city": "KIRBYVILLE",
            "state": "TX",
            "postal_code": "759561652",
            "telephone_number": "409-420-0816",
            "fax_number": "409-420-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 N MARGARET AVE",
            "city": "KIRBYVILLE",
            "state": "TX",
            "postal_code": "759561652",
            "telephone_number": "409-420-0816",
            "fax_number": "409-420-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS FAMILY HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "RATH",
        "authorized_official_first_name": "KALYAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-384-9200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "673880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161594003",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Healthcare- Kirbyville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirbyville, TX

Sources for this page

Verify at the official NPI Registry.