EAST TEXAS MEDICAL CENTER (NPI# 1962483453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962483453 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS MEDICAL CENTER |
| Other Organization Name | ETMC CROCKETT FAMILY MEDICAL CENTER RHC |
| Practice Address |
1100 E Loop 304 Suite 200 Crockett TX 75835-1810 |
| Mailing Address |
Po Box 1304 Pittsburg TX 75686-2203 |
| Practice Telephone | 9365445132 |
| Practice Fax Number | 9365443792 |
| Mailing Telephone | 9365445132 |
| Mailing Fax Number | 9365443792 |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2015-02-24 |
| Authorized Official Name | MR. TERRY CUTLER (ADMINISTRATOR) |
| Authorized Official Telephone | 9365463862 |
| 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 | 095181602 | 05 |
| Other Name | Type Code |
|---|---|
| ETMC Crockett Family Medical Center RHC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568964518 | East Texas Medical Center | Ambulance | 1501 Hogan Lane, Suite H, Bellmead, TX 76705-2480 | 2018-03-06 |
| 1699289785 | East Texas Medical Center | Clinic/Center | 117 N Winnsboro St, Quitman, TX 75783-2144 | 2017-11-28 |
| 1235256884 | East Texas Medical Center | General Acute Care Hospital | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2007-03-26 |
| 1497804371 | East Texas Medical Center | Nurse Anesthetist, Certified Registered | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2007-01-09 |
| Street Address |
1100 E LOOP 304 SUITE 200 |
| City | CROCKETT |
| State | TX |
| Zip Code | 75835-1810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073500799 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2005-09-29 |
| 1194334532 | Patrick Allen Harvey | Pharmacist | 1100 E Loop 304, Crockett, TX 75835-1810 | 2020-07-30 |
| 1114435260 | Crockett Medical Center, LLC | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2018-01-10 |
| 1700269941 | Timberlands Healthcare, LLC | Medicare Defined Swing Bed Unit | 1100 E Loop 304, Crockett, TX 75835-1810 | 2015-07-07 |
| 1306223458 | Timberlands Healthcare, LLC | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2015-04-28 |
| 1013301647 | Lifeguard Ambulanceservice of Texas, LLC | Ambulance | 1100 E Loop 304, Crockett, TX 75835-1810 | 2015-03-20 |
| 1588957856 | Walter Cody Cox | Emergency Medicine | 1100 E Loop 304, Crockett, TX 75835-1810 | 2011-05-19 |
| 1083835219 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2007-05-02 |
| 1326101692 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-12-18 |
| 1831251479 | East Texas Medical Center Crockett | General Acute Care Hospital | 1100 E Loop 304, Crockett, TX 75835-1810 | 2006-12-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568012862 | Ruby R. Adler | Technician | 2301 N 4th Street, Crockett, TX 75835 | 2019-09-18 |
| 1366712978 | Traditions Hospice of Madisonville, LLC | Hospice Care, Community Based | 600e Loop 304, Crockett, TX 75835 | 2012-01-12 |
| 1538458633 | Northeast Texas Home Health Agency Ltd | Home Health | 2001 E Houston Ave, Crockett, TX 75835 | 2011-03-30 |
| 1508096553 | D&c Medical Associates | Family Medicine | 1100 Loop 3048 East, Suite 200, Crockett, TX 75835 | 2009-07-23 |
| 1356466346 | John Vernon Garner | Dentist | 102 North Grace, Crockett, TX 75835 | 2007-03-20 |
| 1023148467 | Houston County Home Health Care, Inc. | Durable Medical Equipment & Medical Supplies | 1703 E Hwy 21 E, Crockett, TX 75835 | 2007-03-06 |
| 1407944382 | Davy Crockett Drug, Inc. | Pharmacy | 107 S 4th St, Crockett, TX 75835 | 2006-10-10 |
| 1437177052 | John Allan Burnett | Emergency Medicine | 1100 Loop 340 E, Crockett, TX 75835 | 2006-07-18 |
| 1720022593 | Stanley Roger Speegle | Family Medicine | 1100 Loop 304 East, Crockett, TX 75835 | 2006-06-15 |
| 1649219809 | Jeanne M. Hopple | Nurse Practitioner | The Heart Institute of East Texas, Crocket, 951 E. Loop 304, Crockett, TX 75835 | 2006-06-05 |
| Find all providers in zip 75835 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003303983 | Crockett Medical Center, LLC | Clinic/Center | 1050 E Loop 304 Ste 201, Crockett, TX 75835-1814 | 2018-04-17 |
| 1205216090 | Timberlands Healthcare, LLC | Clinic/Center | 1050 E Loop 304, Suite 200, Crockett, TX 75835-1814 | 2015-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639776586 | West Texas Family Medicine, Pllc | Clinic/Center | 315 W Cleveland St, Hale Center, TX 79041 | 2020-10-05 |
| 1780298547 | Coryell County Memorial Hospital Authority | Clinic/Center | 498 Avenue E, Moody, TX 76557-3579 | 2020-08-31 |
| 1760005953 | Eastland Memorial Hospital District | Clinic/Center | Walnut Street Clinic, 200 Walnut Street Clinic, Ranger, TX 76448-7644 | 2020-05-21 |
| 1023631306 | Eastland Memorial Hospital District | Clinic/Center | Emh Regional Healthcare Clinic, 2314 W. Commerce Street, Eastland, TX 76448-7644 | 2020-05-21 |
| 1346862752 | Ascension Seton | Clinic/Center | 249 Sportsplex Dr., Suite 204, Dripping Springs, TX 78620-2350 | 2020-05-08 |
| 1255977211 | Frio Hospital Association | Clinic/Center | 801 Fm W 117, Dilley, TX 78017 | 2019-11-25 |
| 1700447950 | Scott & White Hospital - Marble Falls | Clinic/Center | 105 Fm2342, Kingsland, TX 78639-6010 | 2019-06-27 |
| 1275193005 | Brenham Family Practice and Obstetrics Pa | Clinic/Center | 601 Medical Pkwy Ste D, Brenham, TX 77833-5430 | 2019-06-14 |
| 1588137103 | Nocona Hospital District | Clinic/Center | 108 E Boggess St, Saint Jo, TX 76265-0238 | 2019-01-07 |
| 1033687900 | Gainesville Community Hospital, Inc. | Clinic/Center | 801 N Grand Ave Ste 1&4, Gainesville, TX 76240-3573 | 2018-11-08 |
| 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.