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 Rusk

Practice address

1325 N Dickinson Dr
Rusk, TX 75785-1051

Phone

(903) 683-3600

Fax

(903) 683-3692

NPI assigned

Mar 22, 2010

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 Rusk Doing business as

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

{
    "created_epoch": "1269216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1972827822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S RAGSDALE ST",
            "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": "1325 N DICKINSON DR",
            "city": "RUSK",
            "state": "TX",
            "postal_code": "757851051",
            "telephone_number": "903-683-3600",
            "fax_number": "903-683-3692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-22",
        "last_updated": "2011-10-31",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283515901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THSTEPS",
            "identifier": "283515902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETMC First Physicians Clinic Rusk",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joe T Colkin Jr., L.P.C.
• Jacqueline Suzanne Cooper, MA, LPC
• Jeffrey Russell Copeland, PA
• Kaylee Cox
• Developing Hope Counseling Services PLLC
• Amanda Lynn Faught, PHARMD
• Misty Fergusson
• Vashti Jude Forbes, FNP-C
• Brittany Ford
• Cristal Garner, MSN, APRN, PMHNP-BC

• Rural Health Clinic/Center in Rusk, TX
• Providers in Rusk, 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 Oct 31, 2011; 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.