EAST TEXAS MEDICAL CENTER GILMER (NPI# 1619124658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619124658 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS MEDICAL CENTER GILMER |
| Other Organization Name | ETMC PHYSICANS CLINIC |
| Practice Address |
1402 Linda Dr Daingerfield TX 75638-2132 |
| Mailing Address |
Po Box 1237 Gilmer TX 75644-1237 |
| Practice Telephone | 9038417100 |
| Practice Fax Number | 9038417286 |
| Mailing Telephone | 9038417100 |
| Mailing Fax Number | 9038417286 |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-10-27 |
| Authorized Official Name | MR. THOMAS M O'GORMAN (REGIONAL CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9038564520 |
| Is Organization Subpart | Y |
| Parent Organization Name | EAST TEXAS MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | MEDICARE RURAL HEALTH CLINIC | 453406 | 01 |
| TX | 168447406 | 05 | |
| TX | 168447408 | 05 |
| Other Name | Type Code |
|---|---|
| ETMC Physicans Clinic | Other Name - Individual/Organization |
| Street Address |
1402 LINDA DR |
| City | DAINGERFIELD |
| State | TX |
| Zip Code | 75638-2132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013538321 | Titus County Hospital District | Clinic/Center | 1402 Linda Dr, Daingerfield, TX 75638-2132 | 2020-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912156100 | Trey Matthew Latiolais | Dentist | 1106 Broadnax Street, Daingerfield, TX 75638 | 2008-09-12 |
| 1447255278 | Ronald Dickinson | Physician Assistant | 213 A Scurry Ave, Daingerfield, TX 75638 | 2005-06-17 |
| 1245771245 | Morgan Frost | Speech-Language Pathologist | 507 E W M Watson Blvd, Daingerfield, TX 75638 | 2017-03-10 |
| 1194813576 | Danny Lilley | Dentist | 1106 Broadnax St, Daingerfield, TX 75638-1030 | 2006-10-10 |
| 1639607328 | Michelle Phillips | Dentist | 1106 Broadnax St, Daingerfield, TX 75638-1030 | 2017-05-25 |
| 1013454404 | Trey Latiolais Dds Pllc | Dentist | 1106 Broadnax St, Daingerfield, TX 75638-1030 | 2017-01-24 |
| 1376548180 | Lynn Bourdon | Family Medicine | 200 W Scurry St Ste A, Daingerfield, TX 75638-1634 | 2005-06-17 |
| 1548277809 | Roderick Lee Mitchell | Legal Medicine | 303 Webb St, Daingerfield, TX 75638-1651 | 2006-08-01 |
| 1699762443 | Med-care Pharmacy, Inc | Pharmacy | 213 W Scurry St, Daingerfield, TX 75638-1657 | 2005-10-05 |
| 1710176805 | Dickinson & Wells Pllc | Physician Assistant | 213 Scurry Street, A, Daingerfield, TX 75638-1658 | 2007-10-15 |
| Find all providers in zip 75638 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013538321 | Titus County Hospital District | Clinic/Center | 1402 Linda Dr, Daingerfield, TX 75638-2132 | 2020-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639776586 | West Texas Family Medicine, Pllc | Clinic/Center | 315 W Cleveland St, Hale Center, TX 79041 | 2020-10-05 |
| 1780298547 | Coryell County Memorial Hospital Authority | Clinic/Center | 498 Avenue E, Moody, TX 76557-3579 | 2020-08-31 |
| 1760005953 | Eastland Memorial Hospital District | Clinic/Center | Walnut Street Clinic, 200 Walnut Street Clinic, Ranger, TX 76448-7644 | 2020-05-21 |
| 1023631306 | Eastland Memorial Hospital District | Clinic/Center | Emh Regional Healthcare Clinic, 2314 W. Commerce Street, Eastland, TX 76448-7644 | 2020-05-21 |
| 1346862752 | Ascension Seton | Clinic/Center | 249 Sportsplex Dr., Suite 204, Dripping Springs, TX 78620-2350 | 2020-05-08 |
| 1255977211 | Frio Hospital Association | Clinic/Center | 801 Fm W 117, Dilley, TX 78017 | 2019-11-25 |
| 1700447950 | Scott & White Hospital - Marble Falls | Clinic/Center | 105 Fm2342, Kingsland, TX 78639-6010 | 2019-06-27 |
| 1275193005 | Brenham Family Practice and Obstetrics Pa | Clinic/Center | 601 Medical Pkwy Ste D, Brenham, TX 77833-5430 | 2019-06-14 |
| 1588137103 | Nocona Hospital District | Clinic/Center | 108 E Boggess St, Saint Jo, TX 76265-0238 | 2019-01-07 |
| 1033687900 | Gainesville Community Hospital, Inc. | Clinic/Center | 801 N Grand Ave Ste 1&4, Gainesville, TX 76240-3573 | 2018-11-08 |
| Find all providers with the same taxonomy | ||||
| City | DAINGERFIELD |
| Zip Code | 75638 |
Please comment or provide details below to improve the information on EAST TEXAS MEDICAL CENTER GILMER.
| 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.