Active NPI
East Texas Medical Center Carthage
Doing business as ETMC First Physicians Clinic Center III
- Rural Health Clinic/Center
- Carthage, TX
National Provider Identifier
1629314539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- EAST TEXAS MEDICAL CENTER CARTHAGE
- Doing business as
- ETMC First Physicians Clinic Center III
- Practice address
- 305 Cottage Rd
Carthage, TX 75633-1511 - Phone
- (936) 590-4035
- Fax
- (936) 590-4146
- NPI assigned
- Dec 20, 2012
- Last updated
- Aug 14, 2014
- Organization subpart
- Yes
- Parent organization
- EAST TEXAS MEDICAL CENTER CARTHAGE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Gary M Hudson
- Title
- Administrator
- Phone
- (903) 694-4652
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
305 Cottage Rd
Carthage, TX 75633-1511
Mailing address
409 Cottage Rd
Carthage, TX 75633-1466
Phone (903) 694-4652
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3187015-02 | Medicaid | TX | |
| 3187015-01 | Medicaid | TX |
Other names 1
- ETMC First Physicians Clinic Center III
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Part of
- East Texas Medical Center
Ownership & related parties
Change-of-ownership history 1
| Date | Event | Counterparty |
|---|---|---|
| Mar 1, 2018 | Change of Ownership | Ut Health East Texas Carthage Physician Clinic |
Change of ownership 1
Medicare changes of ownership in which this facility was the buyer or the seller.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355961600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1407974400000",
"number": "1629314539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 COTTAGE RD",
"city": "CARTHAGE",
"state": "TX",
"postal_code": "756331466",
"telephone_number": "903-694-4652",
"fax_number": "903-694-4625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 COTTAGE RD",
"city": "CARTHAGE",
"state": "TX",
"postal_code": "756331511",
"telephone_number": "936-590-4035",
"fax_number": "936-590-4146"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAST TEXAS MEDICAL CENTER CARTHAGE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EAST TEXAS MEDICAL CENTER CARTHAGE",
"enumeration_date": "2012-12-20",
"last_updated": "2014-08-14",
"status": "A",
"authorized_official_last_name": "HUDSON",
"authorized_official_first_name": "GARY",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "903-694-4652",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3187015-02",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3187015-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "ETMC First Physicians Clinic Center III",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Carthage, TX
- Emily Dunn, FNP-C
- Adam Duran, MD
- East Texas Medical Center Carthage (ETMC Carthage)
- East Texas Medical Center Carthage (East Texas Medical Center Health Clinic Carthage)
- East Texas Medical Center Carthage (ETMC Carthage)
- East Texas Medical Center Carthage (ETMC First Physician Clinic Carthage)
- East Texas Medical Center Carthage (ETMC Carthage)
- East Texas Medical Center Carthage (ETMC Carthage)
- Eleanor Eckels, LPC
- Olen Wayne English
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.