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Organization

EAST TEXAS MEDICAL CENTER PITTSBURG

Active
Other names
ETMC First Physicians Clinic Mount Vernon
Organization subpart
No

Provider details

NPI number
Authorized official
MR. WILLIAM P HENDERSON (SENIOR ADMINISTRATOR)
(903) 537-8000
Entity
Organization

Contact information

Practice address
506 SOUTH STATE HWY 37, MT VERNON, TX 75457-0477
(903) 537-8222
Mailing address
PO BOX 1304, PITTSBURG, TX 75686-2203
(903) 537-8222

Taxonomy

Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
F4587
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00L04L
BLUE CROSS ETMC RHC
TX
05
136140406
TX
05
136140408
TX
05
136140410
TX
Enumeration date
08/31/2006
Last updated
02/23/2015
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