# EAST TEXAS BORDER HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GENESIS PRIME CARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194332155
- **Authorized official:** CARLA ROADCAP (CEO)
- **Authorized official phone:** (903) 927-3782

## Contact information

- **Practice address:** 1011 S WILLIAM ST, ATLANTA, TX 75551-3245
- **Practice address phone:** (903) 796-2868
- **Practice address fax:** (903) 796-0802
- **Mailing address:** PO BOX 1326, MARSHALL, TX 75671-1326
- **Mailing address phone:** (903) 927-3782
- **Mailing address fax:** (903) 927-1764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QA0005X | Ambulatory Family Planning Facility | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/24/2020
- **Last updated:** 08/05/2024