Organization
EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Active
Other names
East Texas Medical Center Trauma Services
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA MANGUM (VP)
(903) 596-3594
Entity
Organization
Contact information
Practice address
1020 E IDEL ST, TYLER, TX 75701-2024
(903) 596-3555
(903) 596-3560
Mailing address
PO BOX 131027, TYLER, TX 75713-1027
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084245201
—
TX
01
—
CE9194
RAILROAD MEDICARE PIN
TX
Enumeration date
06/29/2006
Last updated
04/11/2017
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