Organization
EAST TEXAS MEDICAL CENTER FAIRFIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RAZ COOK (HOPSITAL ADMINISTRATOR)
(903) 389-1616
Entity
Organization
Contact information
Practice address
125 NEWMAN ST, FAIRFIELD, TX 75840-1419
(903) 389-2121
Mailing address
PO BOX 1939, ATHENS, TX 75751-1939
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
000401
TX
261QR1300X
Rural Health Clinic/Center
000401
TX
275N00000X
Medicare Defined Swing Bed Hospital Unit
000401
TX
282N00000X
General Acute Care Hospital
Primary
000401
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0098DQ
BLUE CROSS BLUE SHIELD
TX
05
—
063474301
—
TX
05
—
063474302
—
TX
05
—
094190801
—
TX
05
—
094190802
—
TX
01
—
HH0713
BLUE CROSS BLUE SHIELD
TX
Enumeration date
01/12/2006
Last updated
05/26/2010
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