Provider Demographics
NPI:1447615943
Name:EAST TEXAS MEDICAL CENTER QUITMAN
Entity Type:Organization
Organization Name:EAST TEXAS MEDICAL CENTER QUITMAN
Other - Org Name:ETMC FIRST PHYSICIANS CLINIC GRAND SALINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SWINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-763-6330
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-2203
Mailing Address - Country:US
Mailing Address - Phone:903-946-5519
Mailing Address - Fax:
Practice Address - Street 1:801 N WALDRIP ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1024
Practice Address - Country:US
Practice Address - Phone:903-962-7551
Practice Address - Fax:903-962-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health