Organization
EAST TEXAS MEDICAL CENTER MOUNT VERNON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM P HENDERSON (SENIOR ADMINISTRATOR)
(903) 537-8000
Entity
Organization
Contact information
Practice address
500 HWY 37 S, MOUNT VERNON, TX 75457-6550
(903) 537-8000
(903) 537-8120
Mailing address
P O BOX 477, 500 SOUTH STATE HWY 37, MOUNT VERNON, TX 75457-0477
(903) 537-8000
(903) 537-8120
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
000282
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C52S
BLUE CROSS CRNA
TX
05
—
136140405
—
TX
Enumeration date
10/19/2006
Last updated
05/25/2010
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