Provider Demographics
NPI:1316029770
Name:EAST TEXAS MEDICAL CENTER HOME SERVICES
Entity Type:Organization
Organization Name:EAST TEXAS MEDICAL CENTER HOME SERVICES
Other - Org Name:EAST TEXAS MEDICAL CENTER HOME HEALTH - NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP. DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-535-6056
Mailing Address - Street 1:19 COUNTY ROAD 4114
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-4199
Mailing Address - Country:US
Mailing Address - Phone:903-856-6554
Mailing Address - Fax:903-856-0084
Practice Address - Street 1:19 COUNTY ROAD 4114
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-4199
Practice Address - Country:US
Practice Address - Phone:903-856-6554
Practice Address - Fax:903-856-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010659251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1383747-02Medicaid
TX677037Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER