ETMC PHYSICIAN GROUP INC. (NPI# 1609382662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609382662 |
| Entity Type | Organization |
| Organization Name | ETMC PHYSICIAN GROUP INC. |
| Practice Address |
1000 S Beckham Ave Tyler TX 75701-1908 |
| Mailing Address |
Po Box 9477 Tyler TX 75711-9477 |
| Practice Telephone | 9035905611 |
| Practice Fax Number | 9035356884 |
| Mailing Telephone | 9035942450 |
| Mailing Fax Number | 9035090493 |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | STEPHEN C PETROVICH (EVP AND SECRETARY) |
| Authorized Official Telephone | 6152963000 |
| Is Organization Subpart | Y |
| Parent Organization Name | AHS EAST TEXAS HEALTH SYSTEM, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891285946 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 1318 Clinic Dr, Tyler, TX 75701-2119 | 2018-05-15 |
| 1821588047 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 612 N High St Ste A, Henderson, TX 75652-5914 | 2018-05-14 |
| 1104316322 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 203 Nacogdoches St Ste 150, Jacksonville, TX 75766-2453 | 2018-05-14 |
| 1720578941 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 1000 E 5th St Ste 400, Tyler, TX 75701-3362 | 2018-05-14 |
| Street Address |
1000 S BECKHAM AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75701-1908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740280510 | Aleksandra Olsson-detwiler | Internal Medicine | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2005-07-22 |
| 1831706431 | Kalana Sanders | Registered Nurse | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-09-28 |
| 1992333975 | Graceanne M. Dimon | Physical Therapist | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-03-27 |
| 1760021976 | Gerardo Tapia Hernandez | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-01-06 |
| 1861950057 | Brittany Mason Ferguson | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2019-03-06 |
| 1255801189 | Shane Ashley Correa | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-12-04 |
| 1174000962 | David Matthew Burkland | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-07-24 |
| 1598251209 | Kelsey Rene Morton | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-07-05 |
| 1063915916 | Tyler Regional Hospital LLC | Surgery | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-03-16 |
| 1437650264 | Tyler Regional Hospital LLC | Nurse Anesthetist, Certified Registered | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-02-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003847716 | Randy Craig Randall | Internal Medicine | 1783 Troup Highway, Tyler, TX 75701 | 2006-07-05 |
| 1396735122 | Carl Noah Israel | Internal Medicine | 1783 Troup Hwy, Tyler, TX 75701-5869 | 2005-10-24 |
| 1639164403 | Peter Harald Langsjoen | Internal Medicine | 1107 Doctors Dr, Tyler, TX 75701-2124 | 2005-09-16 |
| 1285629501 | Christopher Scott Boylan | Internal Medicine | 2608 Mcdonald Rd, Tyler, TX 75701-5934 | 2005-09-13 |
| 1104471465 | Scott A Wright, Md | Internal Medicine | 3219 E Grande Blvd, Tyler, TX 75707-1407 | 2019-08-05 |
| 1568751196 | Pedro Manuel Calderon Artero | Internal Medicine | 703 S Fleishel Ave Ste 4000, Tyler, TX 75701 | 2011-04-05 |
| 1881995983 | Aleksandr Korniyenko | Internal Medicine | 2608 Mcdonald Rd, Tyler, TX 75701-5934 | 2010-11-06 |
| 1619114659 | Rachel Devaney | Internal Medicine | 1783 Troup Hwy, Tyler, TX 75701-5869 | 2009-01-13 |
| 1194973701 | Muhammad Marouf Chaudhry | Internal Medicine | 11937 Us Highway 271, Tyler, TX 75708-3154 | 2008-09-08 |
| 1174784904 | Augustine Njoku | Internal Medicine | 2608 Mcdonald Rd, Tyler, TX 75701-5934 | 2008-06-24 |
| Find all providers in TYLER | ||||
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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.