EAST TEXAS BORDER HEALTH CLINIC (NPI# 1669872560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1669872560 |
Entity Type | Organization |
Organization Name | EAST TEXAS BORDER HEALTH CLINIC |
Other Organization Name | GENESIS PRIMECARE |
Practice Address |
2131 S Mobberly Ave Longview TX 75602-3563 |
Mailing Address |
Po Box 1326 Marshall TX 75671-1326 |
Practice Telephone | 9037583551 |
Mailing Telephone | 9039273782 |
Enumeration Date | 2014-08-27 |
Last Update Date | 2020-09-03 |
Authorized Official Name | MRS. CARLA ROADCAP (CEO) |
Authorized Official Telephone | 9039273782 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TX | 340584701 | 05 |
Other Name | Type Code |
---|---|
GENESIS PRIMECARE | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598366718 | East Texas Border Health Clinic | Clinic/Center | 1411 College Dr, Texarkana, TX 75503-3533 | 2020-11-04 |
1780295741 | East Texas Border Health Clinic | Clinic/Center | 705 S Grove St, Marshall, TX 75670-5220 | 2020-08-13 |
1811485055 | East Texas Border Health Clinic | Clinic/Center | 815 S Washington Ave Ste 203, Marshall, TX 75670-5341 | 2018-04-24 |
1588092472 | East Texas Border Health Clinic | Clinic/Center | 401 N Grove Street, Marshall, TX 75670-3255 | 2013-10-31 |
1700134996 | East Texas Border Health Clinic | General Practice | 1500 W. Grand Ave., Marshall, TX 75671 | 2012-08-21 |
1659567337 | East Texas Border Health Clinic | Clinic/Center | 106 N Alley Street, Jefferson, TX 75657-1408 | 2007-09-17 |
1194332155 | East Texas Border Health Clinic | Social Worker | 1011 S William St, Atlanta, TX 75551-3245 | 2020-09-24 |
1023630969 | East Texas Border Health Clinic | Clinic/Center | 622 S Grove St, Marshall, TX 75670-5251 | 2020-05-14 |
1528616992 | East Texas Border Health Clinic | Pharmacy | 1400 College Dr, Texarkana, TX 75503-3536 | 2019-08-29 |
1548745383 | East Texas Border Health Clinic | Counselor | 4077 Jefferson Ave, Texarkana, AR 71854-1509 | 2018-09-27 |
Street Address |
2131 S MOBBERLY AVE |
City | LONGVIEW |
State | TX |
Zip Code | 75602-3563 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740288430 | Jeffrey William Sewell | Legal Medicine | 2131 S Mobberly Ave, Longview, TX 75602-3563 | 2005-07-07 |
1023426665 | Longview Wellness Center, Inc | Clinic/Center | 2131 S Mobberly Ave, Longview, TX 75602 | 2014-07-28 |
1982954566 | Julia Ann Russell | Nurse Practitioner | 2131 S Mobberly Ave, Longview, TX 75602-3563 | 2012-09-11 |
1033401559 | Paul L. Burch | Physician Assistant | 2131 S Mobberly Ave, Longview, TX 75602-3563 | 2011-05-03 |
1972688497 | Vada Ann Culpepper | Physician Assistant | 2131 S Mobberly Ave, Longview, TX 75602-3563 | 2006-10-25 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083150569 | Mcet-longview | Clinic/Center | 505 North Sixth Street, Longview, TX 75602 | 2017-01-09 |
1962561597 | Robert Lee Harper | Dentist | 1002 So M L King Jr Blvd, Longview, TX 75602 | 2006-12-08 |
1033202700 | Hervey & Bethard Inc. | Durable Medical Equipment & Medical Supplies | 1900 S. High St., Longview, TX 75602 | 2006-10-02 |
1063748796 | Jeffery Michael Stowers | Pharmacist | 1900 S High St, Longview, TX 75602 | 2009-10-31 |
1326541368 | Tonie Elaine Bryant | Licensed Vocational Nurse | 1006 Flanagan Dr, Longview, TX 75602-1013 | 2018-03-15 |
1285145839 | Maria Tran | Specialist/Technologist | 16 Covington Dr, Longview, TX 75602-1071 | 2017-10-21 |
1639635444 | G and T Young At Heart | Counselor | 1012 E Cotton St, Longview, TX 75602-1322 | 2019-02-17 |
1982020038 | Julie A Dollison | Perfusionist | 301 S Club Dr, Longview, TX 75602-1511 | 2014-03-13 |
1881009231 | Brandi Mccracken | Specialist/Technologist, Other | 301 S Club Dr, Longview, TX 75602-1511 | 2014-06-24 |
1578982948 | Community Perfusion Services LLC | Perfusionist | 301 S Club Dr, Longview, TX 75602-1511 | 2014-04-14 |
Find all providers in zip 75602 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518486380 | Longview Wellness Center Inc | Clinic/Center | 1107 E Marshall Ave Bldg 2, Longview, TX 75601-5602 | 2017-09-13 |
1417476284 | Longview Wellness Center Inc | Clinic/Center | 1107 E Marshall Ave Bldg 3, Longview, TX 75601-5602 | 2017-09-13 |
1770122681 | Longview Wellness Center, Inc. | Clinic/Center | 705 E Marshall Ave Ste 3000, Longview, TX 75601-5661 | 2019-12-26 |
1891280277 | Special Health Resources for Texas Incorporated | Clinic/Center | 705 E Marshall Ave Ste 3000, Longview, TX 75601-5661 | 2018-06-27 |
1740783620 | Special Health Resources for Texas, Incorporated | Clinic/Center | 1300 N 6th St, Longview, TX 75601-5567 | 2018-03-16 |
1922556067 | Special Health Resources for Texas, Inc | Clinic/Center | 402 N 7th St, Longview, TX 75601-6704 | 2016-09-19 |
1750769238 | Special Health Resources for Texas Incorporated | Clinic/Center | 703 E Marshall Ave, Suite 310, Longview, TX 75601-5500 | 2015-05-15 |
1184824203 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
1700086824 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
1073711081 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-11 |
Find all providers in LONGVIEW |
Please comment or provide details below to improve the information on EAST TEXAS BORDER HEALTH CLINIC.
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.