| East Texas Medical Center Pittsburg | |
|
506 South State Hwy 37 Mt Vernon TX 75457-0477 | |
| (903) 537-8222 | |
| Not Available |
| Full Name | East Texas Medical Center Pittsburg |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 506 South State Hwy 37, Mt Vernon, Texas |
| Authorized Official Name and Position | William P Henderson (SENIOR ADMINISTRATOR) |
| Authorized Official Contact | 9035378000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Medical Center Pittsburg Po Box 1304 Pittsburg TX 75686-2203 Ph: (903) 537-8222 | East Texas Medical Center Pittsburg 506 South State Hwy 37 Mt Vernon TX 75457-0477 Ph: (903) 537-8222 |
| NPI Number | 1790897189 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 02/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790897189 | NPI | - | NPPES |
| 136140406 | Medicaid | TX | |
| 00L04L | Other | TX | BLUE CROSS ETMC RHC |
| 136140410 | Medicaid | TX | |
| 136140408 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | F4587 (Texas) | Primary |
Premise Health Of Texas Medical, P.a Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 955 Lowes Ln, Mt Vernon, TX 75457 Phone: 903-537-7500 Fax: 903-537-7584 | |
Jean Woel Latortue Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 506 Texas Highway 37 S, Mt Vernon, TX 75457 Phone: 903-767-7666 |