Organization
EAST TEXAS BORDER HEALTH CLINIC
Active
Other names
Genesis Prime Care
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA ROADCAP (CEO)
(903) 927-3782
Entity
Organization
Contact information
Practice address
805 LINDSEY DR, MARSHALL, TX 75670-5271
(903) 938-1146
(903) 927-2434
Mailing address
PO BOX 1326, MARSHALL, TX 75671-1326
(903) 927-3782
(903) 927-1764
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089LZ
BLUECROSS BLUESHIELD
TX
05
—
174139901
—
TX
05
—
192226201
—
TX
Enumeration date
05/03/2006
Last updated
06/13/2024
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