East Texas Clinic Inc

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

EAST TEXAS CLINIC INC

Practice address

201 Pine Tree Rd
Longview, TX 75604-4140

Phone

(903) 759-4966

NPI assigned

Feb 11, 2022

Organization subpart

No

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

Authorized official

Name

Jason Stalnaker

Title

Executive Director

Phone

(903) 759-4966

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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

• Carlton Smith, LCDC

  • Addiction (Substance Use Disorder) Counselor
  • Longview, TX
  • NPI 1407652548
  NPD
• Lynette Vickery, LCDC

  • Addiction (Substance Use Disorder) Counselor
  • Longview, TX
  • NPI 1982400040
  NPD
• Tracey Wisdom, LCDC

  • Addiction (Substance Use Disorder) Counselor
  • Longview, TX
  • NPI 1174329262
  NPD
• Michael Carter Leath, MD

  • Internal Medicine Physician
  • Marshall, TX
  • NPI 1831197524
  NPD (past)

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

{
    "created_epoch": "1644537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1851045595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9486",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756089486",
            "telephone_number": "903-759-4966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PINE TREE RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756044140",
            "telephone_number": "903-759-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "STALNAKER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "903-759-4966"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Texas Careteam, Inc
• East Texas Case Management Referral Service
• East Texas Case Management Referral Service
• East Texas Case Management Referral Service
• East Texas Case Management Referral Service
• East Texas Council on Alcoholism and Drug Abuse
• East Texas Endodonics
• East Texas Gastroenterology Associates, P a
• East Texas Happy Feet Foot Clinic PC
• East Texas Kidney Specialists,PA

• Methadone Clinic in Longview, TX
• Providers in Longview, TX by specialty
• Methadone Clinic in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.