East Texas Medical Center Jacksonville

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

EAST TEXAS MEDICAL CENTER JACKSONVILLE

Doing business as

ETMC First Physicians Clinic Jacksonville

Practice address

203 Nacogdoches St
Suite 280
Jacksonville, TX 75766-2444

Phone

(903) 541-5396

Fax

(903) 541-5393

NPI assigned

Dec 1, 2011

Last updated

Nov 8, 2012By 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

Mr. Jack R Endres

Title

Administrator

Phone

(903) 541-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ETMC First Physicians Clinic Jacksonville Doing business as

Locations

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

{
    "created_epoch": "1322697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352332800000",
    "number": "1821366170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S RAGSDALE ST",
            "address_2": "ADMINISTRATION",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662434",
            "telephone_number": "903-541-5100",
            "fax_number": "903-541-5068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 NACOGDOCHES ST",
            "address_2": "SUITE 280",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662444",
            "telephone_number": "903-541-5396",
            "fax_number": "903-541-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-01",
        "last_updated": "2012-11-08",
        "status": "A",
        "authorized_official_last_name": "ENDRES",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-541-5100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THSTEPS",
            "identifier": "130612808",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130612807",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC First Physicians Clinic Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mikayle Anne Durant, APRN
• Ryan Earle, NP
• East Texas Eye Care Associates PLLC (The Optical Shop)
• East Texas Medical Center Healthcare Associates (First Physicians)
• East Texas Medical Center Jacksonville
• Ruth S Eckenrod, PTA
• Edge Medical Supply, LLC
• Eirah Elmer, LPC-S
• Kenya Sekoni Etim, M.D.
• Etmc Physician Group Inc. (UT Health East Texas Physicians)

• Rural Health Clinic/Center in Jacksonville, TX
• Providers in Jacksonville, 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 Nov 8, 2012; 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.