Organization
EAST TEXAS MEDICAL CENTER ATHENS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAT WALLACE (ADMINISTATOR)
(903) 675-1000
Entity
Organization
Contact information
Practice address
2000 S PALESTINE ST, ATHENS, TX 75751-5610
(903) 675-2216
Mailing address
PO BOX 1996, ATHENS, TX 75751-1996
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
000374
TX
261QR1300X
Rural Health Clinic/Center
000374
TX
282N00000X
General Acute Care Hospital
Primary
000374
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0088DQ
BLUE CROSS BLUE SHIELD
TX
05
—
139173207
—
TX
05
—
139173211
—
TX
05
—
139173213
—
TX
05
—
139713209
—
TX
01
—
HH0406
BLUE CROSS BLUE SHIELD
TX
Enumeration date
01/12/2006
Last updated
12/05/2013
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