EAST TEXAS BORDER HEALTH CLINIC


Address: 2131 S Mobberly Ave, Longview, TX 75602-3563
Phone: 9037583551

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QF0400X Clinic/Center
Specialization: Federally Qualified Health Center (FQHC)
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
TX 340584701 05

Other Provider/Organization Names

Other Name Type Code
GENESIS PRIMECARE Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 2131 S MOBBERLY AVE
City LONGVIEW
State TX
Zip Code 75602-3563

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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

Competitor

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City LONGVIEW
Zip Code 75602

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Dataset Information

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.

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