East Texas Medical Center

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

EAST TEXAS MEDICAL CENTER

Doing business as

ETMC Crockett Family Medical Center RHC

Practice address

1100 E Loop 304
Suite 200
Crockett, TX 75835-1810

Phone

(936) 544-5132

Fax

(936) 544-3792

NPI assigned

Nov 10, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Terry Cutler

Title

Administrator

Phone

(936) 546-3862

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ETMC Crockett Family Medical Center RHC Doing business as

Locations

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1962483453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1304",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756862203",
            "telephone_number": "936-544-5132",
            "fax_number": "936-544-3792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E LOOP 304",
            "address_2": "SUITE 200",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-544-5132",
            "fax_number": "936-544-3792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-10",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "CUTLER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "936-546-3862",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "095181602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC Crockett Family Medical Center RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shemira Davis, QMHP-CS
• Davy Crockett Drug, Inc.
• Davy Crockett Drug, Inc.
• Carol S Dawson, LCSW
• DCD Equipment, Inc
• East Texas Medical Center Crockett
• East Texas Medical Center Crockett
• East Texas Medical Center Crockett
• East Texas Medical Center Crockett
• East Texas Medical Center Crockett

• Rural Health Clinic/Center in Crockett, TX
• Providers in Crockett, 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 Feb 24, 2015; 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.