Organization
EAST TEXAS MEDICAL CENTER QUITMAN
Active
Other names
ETMC First Physicians Clinic Van
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS O'GORMAN (REGIONAL CFO)
(903) 946-5500
Entity
Organization
Contact information
Practice address
113 W MAIN ST, VAN, TX 75790-2883
(903) 963-8303
(903) 963-5863
Mailing address
113 W MAIN ST, VAN, TX 75790-2883
(903) 963-8303
(903) 963-5863
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017625701
—
TX
05
—
063353901
—
TX
Enumeration date
09/20/2005
Last updated
06/14/2010
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