EAST TEXAS MEDICAL CENTER JACKSONVILLE (NPI# 1972827822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972827822 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS MEDICAL CENTER JACKSONVILLE |
| Other Organization Name | ETMC FIRST PHYSICIANS CLINIC RUSK |
| Practice Address |
1325 N Dickinson Dr Rusk TX 75785-1051 |
| Mailing Address |
501 S Ragsdale St Jacksonville TX 75766-2434 |
| Practice Telephone | 9036833600 |
| Practice Fax Number | 9036833692 |
| Mailing Telephone | 9035415100 |
| Mailing Fax Number | 9035415068 |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2011-10-31 |
| 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 | 283515901 | 05 | |
| TX | THSTEPS | 283515902 | 01 |
| Other Name | Type Code |
|---|---|
| ETMC First Physicians Clinic Rusk | 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 |
| 1821366170 | East Texas Medical Center Jacksonville | Clinic/Center | 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2444 | 2011-12-01 |
| 1285689133 | East Texas Medical Center Jacksonville | General Acute Care Hospital | 501 S Ragsdale St, Jacksonville, TX 75766-2467 | 2006-05-22 |
| Street Address |
1325 N DICKINSON DR |
| City | RUSK |
| State | TX |
| Zip Code | 75785-1051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841469244 | Bonner Emergency Medicine Associates Pa | Physician Assistant | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2008-02-29 |
| 1265904411 | Lisa Kathryn Trawick | Nurse Practitioner | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2018-12-28 |
| 1770082299 | Jacksonville Hospital LLC | Clinic/Center | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2018-02-10 |
| 1457702623 | Luke Johnson | Family Medicine | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2016-06-28 |
| 1336507169 | Misty Fergusson | Nurse Practitioner | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2016-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841898137 | Pineywoods Physical Therapy LLC | Clinic/Center | 1400 West 6th Street, Suite 6 and 7, Rusk, TX 75785 | 2020-10-09 |
| 1184124943 | Deanna Adams | Nurse Practitioner | 1884 Fm343, Rusk, TX 75785 | 2018-02-19 |
| 1831584598 | Stacy Black, Dds, Pa | Dentist | 132 Hatchett, Rusk, TX 75785 | 2015-03-31 |
| 1770823759 | Kristina L Waggoner | Nurse Practitioner | 805 North Dickinson Drive, Rusk, TX 75785 | 2013-02-27 |
| 1104146257 | Rebecca Ann Vogt | Speech-Language Pathologist | 2205 East Johnson St., Rusk, TX 75785 | 2010-06-10 |
| 1710179569 | Julana Graham Schwartz | Speech-Language Pathologist | 2205 Johnson Dr., Rusk, TX 75785 | 2007-08-15 |
| 1154443844 | Alva Joy Jones | Counselor | 1400 Hwy 84 West, Cherokee Center, Suite 3, Rusk, TX 75785 | 2007-04-04 |
| 1902946916 | Stanley Self | Psychiatry & Neurology | 1601 North Dickinson Drive, Rusk, TX 75785 | 2007-02-07 |
| 1396895728 | Satyajeet Lahiri | Psychiatry & Neurology | 1601 N Dickinson Drive, Rusk, TX 75785 | 2007-01-10 |
| 1619039641 | Harry Thompson | Psychiatry & Neurology | 1601 Dickinson Drive, Rusk, TX 75785 | 2006-12-15 |
| Find all providers in zip 75785 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770082299 | Jacksonville Hospital LLC | Clinic/Center | 1325 N Dickinson Dr, Rusk, TX 75785-1051 | 2018-02-10 |
| 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.