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
115 MEDICAL CIR STE 100, ATHENS, TX 75751-9004
(903) 603-7067
(903) 802-7125
Mailing address
PO BOX 1610, ATHENS, TX 75751-1610
(903) 910-2015
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
03/04/2021
Last updated
10/18/2023
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