Provider Demographics
NPI:1629087630
Name:EAST TEXAS FAMILY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:EAST TEXAS FAMILY HEALTHCARE PLLC
Other - Org Name:FAMILY HEALTHCARE- KIRBYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-384-9200
Mailing Address - Street 1:1905 N MARGARET AVE
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956-1652
Mailing Address - Country:US
Mailing Address - Phone:409-420-0816
Mailing Address - Fax:409-420-0821
Practice Address - Street 1:1905 N MARGARET AVE
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956-1652
Practice Address - Country:US
Practice Address - Phone:409-420-0816
Practice Address - Fax:409-420-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673880261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161594003Medicaid
TX673880Medicare ID - Type Unspecified