Organization
EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Active
Other names
Texas Trauma and Emergency Care
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA MANGUM (VP)
(903) 595-3594
Entity
Organization
Contact information
Practice address
6210 S BROADWAY AVE, TYLER, TX 75703-4413
(903) 579-2800
(903) 579-2827
Mailing address
PO BOX 8659, TYLER, TX 75711-8659
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152147801
—
TX
Enumeration date
06/15/2006
Last updated
04/11/2017
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