ETMC PHYSICIAN GROUP INC. (NPI# 1104316322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104316322 |
| Entity Type | Organization |
| Organization Name | ETMC PHYSICIAN GROUP INC. |
| Other Organization Name | UT HEALTH EAST TEXAS PHYSICIANS |
| Practice Address |
203 Nacogdoches St Ste 150 Jacksonville TX 75766-2453 |
| Mailing Address |
1 Burton Hills Blvd Ste 250 Nashville TN 37215-6195 |
| Practice Telephone | 9035866289 |
| Mailing Telephone | 6152963000 |
| Mailing Fax Number | 6152966227 |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |
| Authorized Official Name | STEPHEN C. PETROVICH (EVP) |
| Authorized Official Telephone | 6152963000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Other Name | Type Code |
|---|---|
| UT Health East Texas Physicians | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891285946 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 1318 Clinic Dr, Tyler, TX 75701-2119 | 2018-05-15 |
| 1821588047 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 612 N High St Ste A, Henderson, TX 75652-5914 | 2018-05-14 |
| 1720578941 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 1000 E 5th St Ste 400, Tyler, TX 75701-3362 | 2018-05-14 |
| 1609382662 | Etmc Physician Group Inc. | Durable Medical Equipment & Medical Supplies | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2017-12-28 |
| Street Address |
203 NACOGDOCHES ST STE 150 |
| City | JACKSONVILLE |
| State | TX |
| Zip Code | 75766-2453 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518287499 | East Texas Medical Center Healthcare Associates | Durable Medical Equipment & Medical Supplies | 203 Nacogdoches St Ste 150, Jacksonville, TX 75766-2453 | 2010-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770062788 | David Rentz | Occupational Therapy Assistant | 838 Brown St., Jacksonville, TX 75766 | 2018-08-09 |
| 1295233146 | Amanda Dawn Anderson | Licensed Vocational Nurse | Fm 347, Jacksonville, TX 75766 | 2018-01-25 |
| 1467896241 | Christopher Mark Sirianni | Anesthesiology | 2026 S Jackson St Apt 1213, Jacksonville, TX 75766 | 2013-04-23 |
| 1164703047 | Aegis Psychological Consulting LLC | Psychologist | 208 E. Rusk St., Jacksonville, TX 75766 | 2011-09-06 |
| 1952697872 | Melissa Springmeyer | Family Medicine | 2026 South Jacksonville Street, Jacksonville, TX 75766 | 2011-06-20 |
| 1306031018 | Michael Kay Moore | Occupational Therapist | 4155 Cr 3908, Jacksonville, TX 75766 | 2007-09-06 |
| 1730398827 | Cherokee County Health Department | Public Health or Welfare | 510 East Commerce, Jacksonville, TX 75766 | 2007-05-22 |
| 1568689545 | Mary Alice Bone | Preventive Medicine | 510 E. Commerce, Jacksonville, TX 75766 | 2007-04-19 |
| 1619093176 | Assisted Living Concepts Inc | Assisted Living Facility | 211 Phillip Street, Jacksonville, TX 75766 | 2007-03-22 |
| 1265560767 | Anderson Cherokee Community Enrichment Services | Counselor | 1011 College Ave, Jacksonville, TX 75766 | 2007-02-28 |
| Find all providers in zip 75766 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
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| 1578175568 | Mob Enterprises LLC | Durable Medical Equipment & Medical Supplies | 5285 Shad Rd Ste 207, Jacksonville, FL 32257-2038 | 2020-08-20 |
| 1902456106 | Andre' Pollard | Durable Medical Equipment & Medical Supplies | 13700 Sutton Park Dr N Apt 1313, Jacksonville, FL 32224-2277 | 2019-09-19 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1285297838 | Medical Hotspots, Inc | Durable Medical Equipment & Medical Supplies | 5353 Ramona Blvd Ste 3, Jacksonville, FL 32205-4417 | 2019-04-18 |
| 1831657394 | Synergy Pharmacy Medical Consulting LLC | Durable Medical Equipment & Medical Supplies | 3517 Peeler Rd Apt 19, Jacksonville, FL 32277-2491 | 2019-03-04 |
| 1346707262 | Realo Discount Drug Stores of Eastern North Carolina Inc | Durable Medical Equipment & Medical Supplies | 461 Western Blvd Ste 122a, Jacksonville, NC 28546-7637 | 2019-02-27 |
| 1689131617 | Hughston Orthopaedic Southeast PC | Durable Medical Equipment & Medical Supplies | 6699 Gate Pkwy, Jacksonville, FL 32256-8078 | 2019-02-26 |
| 1457816548 | Ceylon Imports LLC | Durable Medical Equipment & Medical Supplies | 10435 Midtown Pkwy Unit 125, Jacksonville, FL 32246-7462 | 2019-02-04 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 75766 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.