Provider Demographics
NPI:1073817755
Name:EMERGENCY SERVICES FOUNDATION OF TEXAS
Entity Type:Organization
Organization Name:EMERGENCY SERVICES FOUNDATION OF TEXAS
Other - Org Name:GENESIS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-688-4205
Mailing Address - Street 1:107 W 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2809
Mailing Address - Country:US
Mailing Address - Phone:806-688-4205
Mailing Address - Fax:806-688-4211
Practice Address - Street 1:107 W 30TH AVE
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2809
Practice Address - Country:US
Practice Address - Phone:806-688-4205
Practice Address - Fax:806-688-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty