EAST TEXAS BORDER HEALTH CLINIC (NPI# 1053663690) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053663690 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS BORDER HEALTH CLINIC |
| Other Organization Name | GENESIS PRIMECARE |
| Practice Address |
1400 College Dr Texarkana TX 75503-3536 |
| Mailing Address |
Po Box 1326 Marshall TX 75671-1326 |
| Practice Telephone | 9037911110 |
| Practice Fax Number | 9037919353 |
| Mailing Telephone | 9039273782 |
| Mailing Fax Number | 9039271764 |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2020-09-03 |
| Authorized Official Name | CARLA ROADCAP (CEO) |
| Authorized Official Telephone | 9039273782 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 198049002 | 05 | |
| TX | 192226202 | 05 |
| Other Name | Type Code |
|---|---|
| Genesis PrimeCare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366718 | East Texas Border Health Clinic | Clinic/Center | 1411 College Dr, Texarkana, TX 75503-3533 | 2020-11-04 |
| 1780295741 | East Texas Border Health Clinic | Clinic/Center | 705 S Grove St, Marshall, TX 75670-5220 | 2020-08-13 |
| 1811485055 | East Texas Border Health Clinic | Clinic/Center | 815 S Washington Ave Ste 203, Marshall, TX 75670-5341 | 2018-04-24 |
| 1588092472 | East Texas Border Health Clinic | Clinic/Center | 401 N Grove Street, Marshall, TX 75670-3255 | 2013-10-31 |
| 1700134996 | East Texas Border Health Clinic | General Practice | 1500 W. Grand Ave., Marshall, TX 75671 | 2012-08-21 |
| 1659567337 | East Texas Border Health Clinic | Clinic/Center | 106 N Alley Street, Jefferson, TX 75657-1408 | 2007-09-17 |
| 1194332155 | East Texas Border Health Clinic | Social Worker | 1011 S William St, Atlanta, TX 75551-3245 | 2020-09-24 |
| 1023630969 | East Texas Border Health Clinic | Clinic/Center | 622 S Grove St, Marshall, TX 75670-5251 | 2020-05-14 |
| 1528616992 | East Texas Border Health Clinic | Pharmacy | 1400 College Dr, Texarkana, TX 75503-3536 | 2019-08-29 |
| 1548745383 | East Texas Border Health Clinic | Counselor | 4077 Jefferson Ave, Texarkana, AR 71854-1509 | 2018-09-27 |
| Street Address |
1400 COLLEGE DR |
| City | TEXARKANA |
| State | TX |
| Zip Code | 75503-3536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063417822 | Thomas Alston | Internal Medicine | 1400 College Dr, Ste 202, Texarkana, TX 75503-3575 | 2005-06-17 |
| 1649898354 | Sarah Khrystine Prine | Dentist | 1400 College Dr, Texarkana, TX 75503-3536 | 2020-07-09 |
| 1528616992 | East Texas Border Health Clinic | Pharmacy | 1400 College Dr, Texarkana, TX 75503-3536 | 2019-08-29 |
| 1104361781 | East Texas Border Health Clinic | Dentist | 1400 College Dr, Texarkana, TX 75503-3536 | 2017-01-05 |
| 1407196264 | Dannah M Smith | Nurse Practitioner | 1400 College Dr, Suite 204, Texarkana, TX 75503 | 2013-02-15 |
| 1184929622 | Andrea K Heflin | Nurse Practitioner | 1400 College Dr, Ste 202, Texarkana, TX 75503-3536 | 2011-01-13 |
| 1356665988 | Kelli Lynn Cook | Social Worker | 1400 College Dr, Texarkana, TX 75503-3536 | 2010-03-25 |
| 1619103058 | Mary Mbonu | Family Medicine | 1400 College Dr, Texarkana, TX 75503-3536 | 2009-05-29 |
| 1033359088 | Ashli Kay Sutton | Counselor | 1400 College Dr, Texarkana, TX 75503-3536 | 2009-03-04 |
| 1689702334 | Glenwood Pharmacy | Pharmacy | 1400 College Dr, Texarkana, TX 75503-3534 | 2007-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770049397 | Jeffery Nash | Nurse Practitioner | #4 Valley View Circle, Texarkana, TX 75503 | 2019-02-19 |
| 1821583501 | Brandy D Acker | Psychologist | 3615 Richmond Rd, Texarkana, TX 75503 | 2018-06-26 |
| 1366935066 | Samantha Lee Harris | Nurse Practitioner | 4116 Mcknight Rd, Texarkana, TX 75503 | 2018-06-07 |
| 1811416910 | Heather Alison Gerber | Nurse Practitioner | 5903 Brenda Street, Texarkana, TX 75503 | 2017-09-11 |
| 1952838682 | John Kyle Abney | Counselor | 4134 Mcknight Rd, Texarkana, TX 75503 | 2017-05-12 |
| 1699151514 | Piney Woods Er IIi LLC | Clinic/Center | 4102 Gibson Lane, Texarkana, TX 75503 | 2015-08-03 |
| 1609282433 | Colby Rebecca Pair | Physician Assistant | 2604 St. Michael Dr., Suite 310, Texarkana, TX 75503 | 2014-07-01 |
| 1265842496 | Healthcare Express, LLP | Clinic/Center | 3513 Richmond Rd, Texarkana, TX 75503 | 2014-04-28 |
| 1134540628 | Eagle Dental Center of Texarkana Pllc | Dentist | 4009 Moores Ln, Texarkana, TX 75503 | 2013-12-30 |
| 1326481664 | Juancarlo S. Pascual | Family Medicine | 604 St. Michael Dr, Suite 340, Texarkana, TX 75503 | 2013-04-16 |
| Find all providers in zip 75503 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366718 | East Texas Border Health Clinic | Clinic/Center | 1411 College Dr, Texarkana, TX 75503-3533 | 2020-11-04 |
| 1831661412 | Special Health Resources for Texas Incorporated | Clinic/Center | 1911 Galleria Oaks Dr, Texarkana, TX 75503-4617 | 2018-12-20 |
| 1942665112 | Special Health Resources for Texas, Inc. | Clinic/Center | 300 E 6th St, Texarkana, AR 71854-5207 | 2015-12-15 |
| 1093186249 | East Texas Border Health Clinic | Clinic/Center | 1205 E 35th St, Texarkana, AR 71854-2746 | 2015-10-14 |
| 1083006084 | East Texas Border Health Clinic | Clinic/Center | 2604 Saint Michael Dr Ste 410, Texarkana, TX 75503-2378 | 2015-02-27 |
| 1326460858 | Special Health Resources for Texas Incorporated | Clinic/Center | 1102 Main St, Texarkana, TX 75501-4313 | 2014-01-17 |
| 1417123258 | Department of Veterans Affairs | Clinic/Center | 910 Realtor Avenue, Texarkana, AR 71854-5066 | 2008-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366043689 | Legacy Community Health Services, Inc. | Clinic/Center | 1900 Strawn Rd., Houston, TX 77039-2017 | 2020-11-03 |
| 1275134595 | Legacy Community Health Services, Inc | Clinic/Center | 507 Crenshaw Rd., Houston, TX 77034-1543 | 2020-11-03 |
| 1912508235 | Legacy Community Health Services, Inc | Clinic/Center | 120 Westheimer Rd., Suite F, Houston, TX 77006-3332 | 2020-11-03 |
| 1720688534 | Barrio Comprehensive Family Health Care Center, Inc. | Clinic/Center | 11930 Us Highway 90, Suite 110, San Antonio, TX 78252 | 2020-10-30 |
| 1053918516 | Legacy Community Health Services, Inc. | Clinic/Center | 13703 Aldine Westfield Rd, Houston, TX 77039-2001 | 2020-10-07 |
| 1205449386 | Matagorda Episcopal Health Outreach Program | Clinic/Center | 2112 Regional Medical Drive Suite 1305, Wharton, TX 77488 | 2020-08-28 |
| 1568075638 | Matagorda Episcopal Health Outreach Program | Clinic/Center | 2112 Regional Medical Center, Suite 1317, Wharton, TX 77488-9719 | 2020-08-28 |
| 1144831835 | Matagorda Episcopal Health Outreach Program | Clinic/Center | 2112 Regional Medical Center Drive Suite 1315, Wharton, TX 77488-9719 | 2020-08-14 |
| 1780295741 | East Texas Border Health Clinic | Clinic/Center | 705 S Grove St, Marshall, TX 75670-5220 | 2020-08-13 |
| 1962013151 | Legacy Community Health Services, Inc | Clinic/Center | 353 Castlegory Dr., Houston, TX 77049-1739 | 2020-08-12 |
| 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.