Organization
EAST TEXAS COMMUNITY CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN W ROBISON (CEO)
(903) 603-9851
Entity
Organization
Contact information
Practice address
801 W MAIN ST, GUN BARREL CITY, TX 75156-5312
(903) 887-1011
(903) 340-8410
Mailing address
PO BOX 1610, ATHENS, TX 75751-1610
(903) 603-9851
(903) 802-7125
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/18/2019
Last updated
05/30/2024
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