East Texas Medical Center Quitman

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

EAST TEXAS MEDICAL CENTER QUITMAN

Doing business as

ETMC First Physicians Clinic Mineola 2

Practice address

1220 N Pacific Ave
Ste 2
Mineola, TX 75773-1054

Phone

(903) 569-0610

Fax

(903) 569-0676

NPI assigned

Jul 30, 2006

Last updated

Aug 5, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas O'Gorman

Title

Regional Cfo

Phone

(903) 946-5520

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ETMC First Physicians Clinic Mineola 2 Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jill Quiambao, RN, FNP-C

  • Family Nurse Practitioner
  • Mineola, TX
  • NPI 1265583504
  NPD (past)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280966400000",
    "number": "1639184369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1304",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756862203",
            "telephone_number": "903-946-5519",
            "fax_number": "903-946-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 N PACIFIC AVE",
            "address_2": "STE 2",
            "city": "MINEOLA",
            "state": "TX",
            "postal_code": "757731054",
            "telephone_number": "903-569-0610",
            "fax_number": "903-569-0676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER QUITMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2010-08-05",
        "status": "A",
        "authorized_official_last_name": "O'GORMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "REGIONAL CFO",
        "authorized_official_telephone_number": "903-946-5520"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017624004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017624006",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC First Physicians Clinic Mineola 2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Henry Clay Davis, LICENSED PROFESSIONA
• Dehaven Optical Center
• Diana Bankhead MD PLLC
• East Texas Counseling & Family Therapy
• East Texas Medical Center Quitman (ETMC First Physicians Clinic Mineola)
• East Texas Rayon Services, LLC
• Elliott-Thomas Health Center PC
• Robert M Elliott, M.D.
• Kathleen Ellsworth
• Evelyn Enamorado

• Rural Health Clinic/Center in Mineola, TX
• Providers in Mineola, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; 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.