East Texas Border Health Clinic
Organization Active NPI Federally Qualified Health Center (FQHC) · Jefferson, TX
NPI 1659567337 · NPPES record last updated Aug 28, 2023
Key facts
- NPI
- 1659567337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- EAST TEXAS BORDER HEALTH CLINIC
- Practice address
- 106 N Alley Street
Jefferson, TX 75657-1408 - Phone
- (903) 665-8453
- Fax
- (903) 665-8496
- NPI assigned
- Sep 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Carla Roadcap
- Title
- Ceo
- Phone
- (903) 927-3782
Other NPIs on the same Medicare enrollment 17
Practitioners 3
-
Sherrie L Fitts, APN
-
Nita Ann Little, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050511001030 | TX | Part B Supplier - Clinic/Group Practice | 8820038565 |
Receives reassigned benefits from 50 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marshall, TX; Texarkana, TX; Atlanta, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
106 N Alley Street
Jefferson, TX 75657-1408
Mailing address
PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 174139903 | Medicaid | TX |
Other providers in Jefferson, TX
- Rose Devine Davis
- Edna M Dixon
- Tammy K Dupree
- Thomas R. Dupree Jr.
- Cally Elizabeth Eans
- Daniqualon V Edwards
- Trinity Dawn Edwards
- Lola Elliott
- Karrie Suzanne Esbenshade
- Etx Dental PLLC
All providers in Jefferson, TX · Federally Qualified Health Center (FQHC) 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 28, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.