Provider Demographics
NPI:1447208855
Name:EAST TEXAS RADIOLOGICAL CONSULTANTS P A
Entity Type:Organization
Organization Name:EAST TEXAS RADIOLOGICAL CONSULTANTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:SMITSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:903-675-6778
Mailing Address - Street 1:810 LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3446
Mailing Address - Country:US
Mailing Address - Phone:903-675-6778
Mailing Address - Fax:903-675-2333
Practice Address - Street 1:810 LUCAS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3446
Practice Address - Country:US
Practice Address - Phone:903-675-6778
Practice Address - Fax:903-675-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MT62Medicare PIN