Provider Demographics
NPI:1568964518
Name:EAST TEXAS MEDICAL CENTER
Entity Type:Organization
Organization Name:EAST TEXAS MEDICAL CENTER
Other - Org Name:ETMC EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-535-5802
Mailing Address - Street 1:352 SOUTH GLENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-6936
Mailing Address - Country:US
Mailing Address - Phone:903-590-5878
Mailing Address - Fax:
Practice Address - Street 1:1501 HOGAN LANE
Practice Address - Street 2:SUITE H
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705-2480
Practice Address - Country:US
Practice Address - Phone:254-799-7718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10009563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport