NPIMap

Organization Active NPI

East Texas Family Support Clinic

  • Pain Clinic/Center
  • Tyler, TX
National Provider Identifier
1699315499
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
Legal business name
EAST TEXAS FAMILY SUPPORT CLINIC
Practice address
1305 Doctors Dr
Tyler, TX 75701-2263
Phone
(903) 525-9397
Fax
(903) 525-9398
NPI assigned
Jan 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Authorized official

Name
Jennifer A Blake
Title
Owner
Phone
(954) 557-2775

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Medical Specialty Clinic/Center 261QM2500X
Pain Clinic/Center 261QP3300X Primary

Addresses

Primary practice location

1305 Doctors Dr
Tyler, TX 75701-2263

Mailing address

1305 Doctors Dr
Tyler, TX 75701-2263
Phone (903) 525-9397

National Provider Directory

National Provider Directory

Locations

1809 W Loop 281
Ste 122
Longview, TX 75604
Phone (903) 525-9397

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1699315499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 DOCTORS DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012263",
            "telephone_number": "903-525-9397",
            "fax_number": "903-525-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 DOCTORS DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012263",
            "telephone_number": "903-525-9397",
            "fax_number": "903-525-9398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS FAMILY SUPPORT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-557-2775"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; 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.