Provider Demographics
NPI:1366452690
Name:EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES
Other - Org Name:FIRST PHYSICIANS ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-596-3813
Mailing Address - Street 1:PO BOX 9624
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2624
Mailing Address - Country:US
Mailing Address - Phone:903-596-7902
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE #600
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-596-3813
Practice Address - Fax:903-596-3843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCC7791OtherRAILROAD MEDICARE
TX00T07KOtherBCBS OF TEXAS
TXCC7791OtherRAILROAD MEDICARE