Organization
EAST TEXAS PHYSICIANS ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLI ARMOUR (CREDENTIALING COORDINATOR)
(903) 731-4700
Entity
Organization
Contact information
Practice address
4002 S LOOP 256, PALESTINE, TX 75801-8491
(903) 731-4700
(903) 731-4699
Mailing address
PO BOX 4550, PALESTINE, TX 75802-4550
(903) 731-4700
(903) 731-4699
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D0483768
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178799601
—
TX
Enumeration date
06/09/2008
Last updated
07/11/2008
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