Provider Demographics
NPI:1629669684
Name:ETX MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:ETX MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-299-4448
Mailing Address - Street 1:4310 DOWLEN RD STE 16
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6861
Mailing Address - Country:US
Mailing Address - Phone:409-299-4448
Mailing Address - Fax:
Practice Address - Street 1:4310 DOWLEN RD STE 16
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6861
Practice Address - Country:US
Practice Address - Phone:409-299-4448
Practice Address - Fax:409-299-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care