Organization
EAST TEXAS MEDICAL ALLIANCE LLP
Active
Other names
First MedChoice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT GENE BLACKWELL M.D. (MANAGING PARTNER)
(903) 723-8554
Entity
Organization
Contact information
Practice address
111 MEDICAL DRIVE, PALESTINE, TX 75801-4781
(903) 723-8554
(903) 723-2054
Mailing address
115 MEDICAL DRIVE, PALESTINE, TX 75801-4781
(903) 723-8554
(903) 723-2054
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R18C
BLUE CROSS GROUP NUMBER
TX
05
—
111610501
—
TX
01
—
111610503
EPSDT GROUP NUMBER
TX
01
—
CQ2287
RR MEDICARE NUMBER
TX
Enumeration date
03/28/2007
Last updated
12/02/2011
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