EAST TEXAS MEDICAL CENTER JACKSONVILLE (NPI# 1821366170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821366170 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS MEDICAL CENTER JACKSONVILLE |
| Other Organization Name | ETMC FIRST PHYSICIANS CLINIC JACKSONVILLE |
| Practice Address |
203 Nacogdoches St Suite 280 Jacksonville TX 75766-2444 |
| Mailing Address |
501 S Ragsdale St Administration Jacksonville TX 75766-2434 |
| Practice Telephone | 9035415396 |
| Practice Fax Number | 9035415393 |
| Mailing Telephone | 9035415100 |
| Mailing Fax Number | 9035415068 |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2012-11-08 |
| Authorized Official Name | MR. JACK R ENDRES (ADMINISTRATOR) |
| Authorized Official Telephone | 9035415100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | THSTEPS | 130612808 | 01 |
| TX | 130612807 | 05 |
| Other Name | Type Code |
|---|---|
| ETMC First Physicians Clinic Jacksonville | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023342755 | East Texas Medical Center Jacksonville | Clinic/Center | 580 North Frankston Highway, Frankston, TX 75763-2654 | 2009-09-29 |
| 1972827822 | East Texas Medical Center Jacksonville | Clinic/Center | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2010-03-22 |
| 1285689133 | East Texas Medical Center Jacksonville | General Acute Care Hospital | 501 S Ragsdale St, Jacksonville, TX 75766-2467 | 2006-05-22 |
| Street Address |
203 NACOGDOCHES ST SUITE 280 |
| City | JACKSONVILLE |
| State | TX |
| Zip Code | 75766-2444 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861491920 | Todd Alan Parrish | Orthopaedic Surgery | 203 Nacogdoches St, Suite 150, Jacksonville, TX 75766-2462 | 2005-07-20 |
| 1265727457 | Courtney E Rose | Pediatrics | 203 Nacogdoches St, Suite 275, Jacksonville, TX 75766-2462 | 2011-06-15 |
| 1588956866 | James R Low, Jr., M.d.,p.a. | Internal Medicine | 203 Nacogdoches St, Ste 360, Jacksonville, TX 75766-2462 | 2011-05-05 |
| 1568783249 | James A. Thurow, D.o., P.a. | Internal Medicine | 203 Nacogdoches St, Suite 180, Jacksonville, TX 75766-2462 | 2010-06-17 |
| 1821316498 | Dogwood Orthopaedic Clinic, Pa | Durable Medical Equipment & Medical Supplies | 203 Nacogdoches St, Suite 150, Jacksonville, TX 75766-2462 | 2010-05-06 |
| 1679898886 | Charles P Cameron | Pediatrics | 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2462 | 2010-03-30 |
| 1053635391 | Traci Cameron | Nurse Practitioner | 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2462 | 2010-03-16 |
| 1003144361 | Surgical Associates of Cherokee County Pa | Surgery | 203 Nacogdoches St, Suite 260, Jacksonville, TX 75766-2462 | 2009-11-25 |
| 1720025067 | Melvin Wayne Cooper | Internal Medicine | 203 Nacogdoches St, Ste 240, Jacksonville, TX 75766-2462 | 2006-06-02 |
| 1760464366 | Guillermo Alfonso Saade | Internal Medicine | 203 Nacogdoches St, Ste 290, Jacksonville, TX 75766-2444 | 2005-11-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770062788 | David Rentz | Occupational Therapy Assistant | 838 Brown St., Jacksonville, TX 75766 | 2018-08-09 |
| 1295233146 | Amanda Dawn Anderson | Licensed Vocational Nurse | Fm 347, Jacksonville, TX 75766 | 2018-01-25 |
| 1467896241 | Christopher Mark Sirianni | Anesthesiology | 2026 S Jackson St Apt 1213, Jacksonville, TX 75766 | 2013-04-23 |
| 1164703047 | Aegis Psychological Consulting LLC | Psychologist | 208 E. Rusk St., Jacksonville, TX 75766 | 2011-09-06 |
| 1952697872 | Melissa Springmeyer | Family Medicine | 2026 South Jacksonville Street, Jacksonville, TX 75766 | 2011-06-20 |
| 1306031018 | Michael Kay Moore | Occupational Therapist | 4155 Cr 3908, Jacksonville, TX 75766 | 2007-09-06 |
| 1730398827 | Cherokee County Health Department | Public Health or Welfare | 510 East Commerce, Jacksonville, TX 75766 | 2007-05-22 |
| 1568689545 | Mary Alice Bone | Preventive Medicine | 510 E. Commerce, Jacksonville, TX 75766 | 2007-04-19 |
| 1619093176 | Assisted Living Concepts Inc | Assisted Living Facility | 211 Phillip Street, Jacksonville, TX 75766 | 2007-03-22 |
| 1265560767 | Anderson Cherokee Community Enrichment Services | Counselor | 1011 College Ave, Jacksonville, TX 75766 | 2007-02-28 |
| Find all providers in zip 75766 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053804443 | Siu Physicians & Surgeons, Inc | Clinic/Center | 610 N Westgate Ave, Jacksonville, IL 62650-1152 | 2018-06-11 |
| 1861991226 | Jacksonville Hospital LLC | Clinic/Center | 203 Nacogdoches St Ste 280, Jacksonville, TX 75766-2444 | 2018-02-12 |
| 1922410836 | Passavant Physician Association | Clinic/Center | 557 N Westgate Ave, Jacksonville, IL 62650-1156 | 2014-05-27 |
| 1205180056 | Memorial Physician Services | Clinic/Center | 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650-1136 | 2012-11-01 |
| 1104179415 | Memorial Physician Services | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2012-10-24 |
| 1558614867 | Memorial Physician Services | Clinic/Center | 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 | 2012-10-24 |
| 1881947174 | Memorial Physician Services | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2012-10-24 |
| 1598068793 | Springfield Clinic LLP | Clinic/Center | 15 Founders Ln, Jacksonville, IL 62650-3919 | 2010-12-09 |
| 1619129897 | Jacksonville, LLC | Clinic/Center | 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 | 2008-10-21 |
| 1437301611 | Jacksonville, LLC | Clinic/Center | 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 | 2008-10-21 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 75766 |
Please comment or provide details below to improve the information on EAST TEXAS MEDICAL CENTER JACKSONVILLE.
| 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.