Organization
EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Active
Other names
ETMC First Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM PEARSON-WAHL (VICE PRESIDENT)
(903) 535-6890
Entity
Organization
Contact information
Practice address
904 S BECKHAM AVE, TYLER, TX 75701-1906
(903) 596-3555
(903) 596-3560
Mailing address
PO BOX 9477, TYLER, TX 75711-9477
(903) 594-2450
(903) 939-0610
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T07K
BLUE CROSS
TX
01
—
CD9882
RAILROAD MEDICARE
TX
Enumeration date
12/21/2007
Last updated
12/21/2007
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