EAST TEXAS TREATMENT CENTER (NPI# 1023002425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023002425 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS TREATMENT CENTER |
| Practice Address |
1200 Dudley Rd Kilgore TX 75662-3306 |
| Practice Telephone | 9039845571 |
| Practice Fax Number | 9039841913 |
| Mailing Telephone | 9039845571 |
| Mailing Fax Number | 9039841913 |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2020-08-18 |
| Authorized Official Name | MS. LAUREN CAMMACK (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9039845571 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | 605680000 | TX | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 121835602 | 05 |
| Street Address |
1200 DUDLEY RD |
| City | KILGORE |
| State | TX |
| Zip Code | 75662-3306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962710962 | Shirley Jane Goetze | Speech-Language Pathologist | 1200 Dudley Rd, Kilgore, TX 75662-3306 | 2010-09-24 |
| 1871622050 | Carol Ann Lambert | Clinic/Center | 1200 Dudley Rd, Kilgore, TX 75662-3306 | 2007-03-05 |
| 1063502888 | Cynthia Kulak | Physical Therapist | 1200 Dudley Rd, Kilgore, TX 75662-3306 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346890621 | Linda Gail Watson | Technician | 190 Glendale St, Kilgore, TX 75662 | 2019-09-18 |
| 1174185151 | Jennifer Darlene Franks | Registered Nurse | 6144 Gateway Center Pmb # 320, Kilgore, TX 75662 | 2019-07-01 |
| 1215363312 | Kilgore Integrated Health Pllc | Chiropractor | 726 Us Highway 259 N, Kilgore, TX 75662 | 2013-09-20 |
| 1407172240 | Jeffrey Alan Davis | Specialist/Technologist | 300 N. Kilgore Street, Kilgore, TX 75662 | 2010-04-19 |
| 1396923777 | Rachel Thunder Rose Wyatt | Physical Therapist | 1200 Dudley Road, Kilgore, TX 75662 | 2008-02-07 |
| 1346313673 | Brookshire Grocery Company | Pharmacy | 747 Hwy 259 North, Attention Pharmacy Dept, Kilgore, TX 75662 | 2006-11-16 |
| 1417026451 | Jeffery John Pinkerton | Optometrist | 800 Highway 259 North, Kilgore, TX 75662 | 2006-11-06 |
| 1831205004 | Joseph Claude De Graffenried Jr. | Dentist | 238 Lawrence St, Kilgore, TX 75662 | 2006-08-21 |
| 1235159500 | Charles Robert Cottier | Chiropractor | 316 Henderson, Kilgome, TX 75662 | 2006-07-20 |
| 1346509494 | Kelton Hospice, Inc. | Hospice Care, Community Based | 1100 Stone Road, Suite 269, Kilgore, TX 75662 | 2012-05-10 |
| Find all providers in zip 75662 | ||||
| Taxonomy Code | 261QR0401X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871622050 | Carol Ann Lambert | Clinic/Center | 1200 Dudley Rd, Kilgore, TX 75662-3306 | 2007-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447807615 | Rise Up Rehab, LLC | Clinic/Center | 1687 Old Hwy 90, Castroville, TX 78009 | 2019-08-22 |
| 1346897709 | Rise Up Rehab, LLC | Clinic/Center | 10410 Parrigin Rd, Helotes, TX 78023-4283 | 2019-08-21 |
| 1376016410 | Elite 360 Health and Wellness | Clinic/Center | 1409 S Lamar, Ste. 245, Dallas, TX 75215-6818 | 2019-01-10 |
| 1902333792 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 21004 Interstate 45 N, Spring, TX 77373-2917 | 2017-05-11 |
| 1023544418 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 5095 Preston Ave, Pasadena, TX 77505-2053 | 2017-05-04 |
| 1871029264 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 4818 E Sam Houston Pkwy N, Houston, TX 77015-3240 | 2017-05-04 |
| 1356793509 | Individual | Clinic/Center | 3500 Timberwood Cir Apt 2137, Arlington, TX 76015-3129 | 2016-07-11 |
| 1801242839 | Transitional Learning Center At Galveston | Clinic/Center | 4416 10th St, Lubbock, TX 79416-4800 | 2016-05-09 |
| 1225401805 | Milestones | Clinic/Center | 2704 S 26th St, Mcallen, TX 78503-7812 | 2015-11-04 |
| 1326421173 | Costa Therapy Institute, LLC | Clinic/Center | 1058 Palm Blvd, Brownsville, TX 78520-6168 | 2015-06-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.