Etmc Physician Group Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ETMC PHYSICIAN GROUP INC.

Doing business as

UT Health East Texas Physicians

Practice address

1318 Clinic Dr
Tyler, TX 75701-2119

Phone

(903) 597-9622

NPI assigned

May 15, 2018

Organization subpart

No

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

Authorized official

Name

Stephen C. Petrovich

Title

Evp

Phone

(615) 296-3000

Specialties & licenses 1

Addresses

Other names 1

• UT Health East Texas Physicians Doing business as

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1891285946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURTON HILLS BLVD STE 250",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156195",
            "telephone_number": "615-296-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 CLINIC DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012119",
            "telephone_number": "903-597-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETMC PHYSICIAN GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UT Health East Texas Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UT Health East Texas Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Tyler, TX
• Providers in Tyler, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.