Organization
EAST TEXAS MEDICAL CENTER JACKSONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK R ENDRES (ADMINISTRATOR)
(903) 541-5000
Entity
Organization
Contact information
Practice address
501 S RAGSDALE ST, JACKSONVILLE, TX 75766-2467
(903) 541-5000
(903) 541-5067
Mailing address
501 S RAGSDALE ST, JACKSONVILLE, TX 75766-2467
(903) 541-5000
(903) 541-5067
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
000416
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J11A
BCBS PROVIDER NUMBER
TX
01
—
1023342755
DBA ETMC FIRST PHYSICIANS CLINIC FRANKSTON
TX
05
—
130612801
—
TX
05
—
130612804
—
TX
05
—
130612806
—
TX
01
—
1972827822
DBA ETMC FIRST PHYSICIANS CLINIC RUSK
TX
05
—
201848301
—
TX
01
—
HH0170
BCBS PROVIDER NUMBER
TX
Enumeration date
05/22/2006
Last updated
12/02/2010
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