Provider Demographics
NPI:1093773707
Name:EAST TEXAS PHYSICIANS CARE PA
Entity Type:Organization
Organization Name:EAST TEXAS PHYSICIANS CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUGMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:936-560-3800
Mailing Address - Street 1:1002 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4437
Mailing Address - Country:US
Mailing Address - Phone:936-560-3800
Mailing Address - Fax:936-560-0102
Practice Address - Street 1:1002 MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4437
Practice Address - Country:US
Practice Address - Phone:936-560-3800
Practice Address - Fax:936-560-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0840894-01Medicaid
TXEA000N19TMedicare ID - Type Unspecified