Organization
EAST TEXAS MEDICAL CENTER JACKSONVILLE
Active
Other names
ETMC First Physicians Clinic Rusk
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK R ENDRES (ADMINISTRATOR)
(903) 541-5100
Entity
Organization
Contact information
Practice address
1325 N DICKINSON DR, RUSK, TX 75785-1051
(903) 683-3600
(903) 683-3692
Mailing address
501 S RAGSDALE ST, JACKSONVILLE, TX 75766-2434
(903) 541-5100
(903) 541-5068
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283515901
—
TX
01
—
283515902
THSTEPS
TX
Enumeration date
03/22/2010
Last updated
10/31/2011
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