East Texas Medical Center Carthage
Organization Active NPI Rural Health Clinic/Center · Carthage, TX
NPI 1629314539 · NPPES record last updated Aug 14, 2014
Key facts
- NPI
- 1629314539
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- EAST TEXAS MEDICAL CENTER CARTHAGE
- Practice address
- 305 Cottage Rd
Carthage, TX 75633-1511 - Phone
- (936) 590-4035
- Fax
- (936) 590-4146
- NPI assigned
- Dec 20, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- EAST TEXAS MEDICAL CENTER CARTHAGE
Authorized official
- Name
- Mr. Gary M Hudson
- Title
- Administrator
- Phone
- (903) 694-4652
Change of ownership 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Mar 1, 2018 | Change of Ownership |
Ut Health East Texas Carthage Physician Clinic |
National Provider Directory
- Part of
- East Texas Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3187015-02 | Medicaid | TX | |
| 3187015-01 | Medicaid | TX |
Other names
- ETMC First Physicians Clinic Center III
Other providers in Carthage, TX
- Emily Dunn
- Adam Duran
- East Texas Medical Center Carthage
- East Texas Medical Center Carthage
- East Texas Medical Center Carthage
- East Texas Medical Center Carthage
- East Texas Medical Center Carthage
- East Texas Medical Center Carthage
- Eleanor Eckels
- Olen Wayne English
All providers in Carthage, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.