Organization
EAST TEXAS BORDER HEALTH CLINIC
Active
Other names
Genesis PrimeCare
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA ROADCAP (CEO)
(903) 927-3782
Entity
Organization
Contact information
Practice address
1205 E 35TH ST, TEXARKANA, AR 71854-2746
(870) 216-0080
(870) 216-0093
Mailing address
PO BOX 1326, MARSHALL, TX 75671-1326
(903) 927-3782
(903) 927-1764
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213389749
—
AR
05
—
356940201
—
TX
Enumeration date
10/14/2015
Last updated
12/12/2024
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