Provider Demographics
NPI:1770754335
Name:EAST TEXAS FAMILY HEALTHCARE, PLLC
Entity type:Organization
Organization Name:EAST TEXAS FAMILY HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALYAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:RATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-384-9200
Mailing Address - Street 1:1273 S PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4915
Mailing Address - Country:US
Mailing Address - Phone:409-384-9200
Mailing Address - Fax:
Practice Address - Street 1:1273 S PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4915
Practice Address - Country:US
Practice Address - Phone:409-384-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXK1016208000000X
TXL0429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty