Active NPI
East Texas Medical Center Healthcare Associates
Doing business as ETMC First Physicians
- Family Medicine Physician
- Tyler, TX
National Provider Identifier
1629252937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
- Doing business as
- ETMC First Physicians
- Practice address
- 904 S Beckham Ave
Tyler, TX 75701-1906 - Phone
- (903) 596-3555
- Fax
- (903) 596-3560
- NPI assigned
- Dec 21, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Kim Pearson-Wahl
- Title
- Vice President
- Phone
- (903) 535-6890
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Cardiovascular Disease Physician | 207RC0000X | |||
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | |||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Orthopaedic Surgery Physician | 207X00000X | |||
| Pediatrics Physician | 208000000X | |||
| Surgery Physician | 208600000X | |||
| Urology Physician | 208800000X | |||
| Pain Medicine Physician | 208VP0000X | |||
| Interventional Pain Medicine Physician | 208VP0014X | |||
| Podiatrist | 213E00000X | |||
| Physician Assistant | 363A00000X | |||
| Nurse Practitioner | 363L00000X |
Addresses
Primary practice location
904 S Beckham Ave
Tyler, TX 75701-1906
Mailing address
PO Box 9477
Tyler, TX 75711-9477
Phone (903) 594-2450
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00T07K | Other | TX | BLUE CROSS |
| CD9882 | Other | TX | RAILROAD MEDICARE |
Other names 1
- ETMC First Physicians
National Provider Directory
National Provider Directory- Tax ID family
- East Texas Medical Center Healthcare Associates
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
dba ETMC First Physicians
- Family Medicine Physician
- Tyler, TX
- NPI 1174707483
-
- Critical Access Hospital
- Tyler, TX
- NPI 1588913834
-
- Family Nurse Practitioner
- Tyler, TX
- NPI 1366743643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198195200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1198195200000",
"number": "1629252937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9477",
"city": "TYLER",
"state": "TX",
"postal_code": "757119477",
"telephone_number": "903-594-2450",
"fax_number": "903-939-0610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 S BECKHAM AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757011906",
"telephone_number": "903-596-3555",
"fax_number": "903-596-3560"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2007-12-21",
"last_updated": "2007-12-21",
"status": "A",
"authorized_official_last_name": "PEARSON-WAHL",
"authorized_official_first_name": "KIM",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "903-535-6890",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Chiropractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RE0101X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Pain Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "00T07K",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CD9882",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "ETMC First Physicians",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tyler, TX
- East Texas Medical Center Healthcare Associates (First Physicians Orthopedics)
- East Texas Medical Center Healthcare Associates (East Texas Medical Center Trauma Services)
- East Texas Medical Center Healthcare Associates (ETMC First Physicians)
- East Texas Medical Center Healthcare Associates (First Physicians)
- East Texas Medical Center Healthcare Associates (East Texas Pathology Services)
- East Texas Medical Center Healthcare Associates (East Texas Emergency Physicians)
- East Texas Medical Center Rehabilitation Hospital
- East Texas Medical Center Specialty Hospital
- East Texas Medical Center Tyler
- East Texas Medical Home Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.