| East Texas Clinical Services Inc | |
|
9201 Pinecroft Dr Shenandoah TX 77380-3222 | |
| (832) 246-8000 | |
| (832) 246-8100 |
| Full Name | East Texas Clinical Services Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9201 Pinecroft Dr, Shenandoah, Texas |
| Authorized Official Name and Position | Matthew C Wright (VICE PRESIDENT) |
| Authorized Official Contact | 2142131152 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Clinical Services Inc 6624 Fannin St Suite 2500 Houston TX 77030-2312 Ph: (832) 355-3403 | East Texas Clinical Services Inc 9201 Pinecroft Dr Shenandoah TX 77380-3222 Ph: (832) 246-8000 |
| NPI Number | 1326596776 |
|---|---|
| Provider Enumeration Date | 09/14/2016 |
| Last Update Date | 09/14/2016 |
| Medicare PECOS PAC ID | 8224319983 |
|---|---|
| Medicare Enrollment ID | O20170111002911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326596776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Texas) | Primary |
| Provider Name | Jennifer S Dong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770511487 PECOS PAC ID: 4789672379 Enrollment ID: I20040503001426 |
| Provider Name | Peter C Bigler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033130042 PECOS PAC ID: 6406831015 Enrollment ID: I20040618001262 |
| Provider Name | Jennifer Lynn Chilek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609817436 PECOS PAC ID: 2365413804 Enrollment ID: I20040806000376 |
| Provider Name | Chun Kwok Wong |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1356439087 PECOS PAC ID: 8729054648 Enrollment ID: I20040902000534 |
| Provider Name | Elizabeth A Coon Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104856723 PECOS PAC ID: 6406814532 Enrollment ID: I20041221000734 |
| Provider Name | Aurora V Yllana Shepperd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538151634 PECOS PAC ID: 7719936491 Enrollment ID: I20050124000235 |
| Provider Name | Kent Ian Kossoy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1356322416 PECOS PAC ID: 8325083157 Enrollment ID: I20050622001118 |
| Provider Name | Jeremy K Mcwilliams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851325823 PECOS PAC ID: 4880625292 Enrollment ID: I20050825000653 |
| Provider Name | Irene Gelman |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1083711964 PECOS PAC ID: 0345273876 Enrollment ID: I20050915000361 |
| Provider Name | Edward S Mansour |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1598701393 PECOS PAC ID: 5799743787 Enrollment ID: I20050929000159 |
| Provider Name | Ajay Mitter |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1174587307 PECOS PAC ID: 2264434158 Enrollment ID: I20070206000259 |
| Provider Name | Richard S Brown |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164511796 PECOS PAC ID: 3870599103 Enrollment ID: I20070327000083 |
| Provider Name | Jon-cecil M Walkes |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1669472288 PECOS PAC ID: 7012014541 Enrollment ID: I20070517000689 |
| Provider Name | Yelena V Bracchini |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1538360896 PECOS PAC ID: 5092803098 Enrollment ID: I20071108000229 |
| Provider Name | Steven K Chon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053438465 PECOS PAC ID: 6002905270 Enrollment ID: I20071211000517 |
| Provider Name | Kathryn Marie Lewis |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1215920640 PECOS PAC ID: 4486725280 Enrollment ID: I20080623000375 |
| Provider Name | John W Davis |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1003858127 PECOS PAC ID: 6608859368 Enrollment ID: I20090115000119 |
| Provider Name | Akinyinka Abidem Ajelabi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1841227808 PECOS PAC ID: 8729044789 Enrollment ID: I20090210000749 |
| Provider Name | Sandra Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154507242 PECOS PAC ID: 0345307658 Enrollment ID: I20090331000280 |
| Provider Name | Jerissa P Belsha |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730412065 PECOS PAC ID: 4789721069 Enrollment ID: I20091019000247 |
| Provider Name | Angela Y Mosley-nunnery |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326155219 PECOS PAC ID: 6103967948 Enrollment ID: I20091230000631 |
| Provider Name | Allan H Daniels |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538265905 PECOS PAC ID: 7719028554 Enrollment ID: I20091230000656 |
| Provider Name | Kim Elliott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407954738 PECOS PAC ID: 5799826632 Enrollment ID: I20100114000065 |
| Provider Name | Michael W Morris |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1114980430 PECOS PAC ID: 4385788165 Enrollment ID: I20100217000297 |
| Provider Name | Ulupi A Choksi |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1891851531 PECOS PAC ID: 1759425473 Enrollment ID: I20100218000843 |
| Provider Name | Martin Vestal Caperton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154416824 PECOS PAC ID: 4183751993 Enrollment ID: I20100428000316 |
| Provider Name | Arlean M Bullard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104816735 PECOS PAC ID: 5092845479 Enrollment ID: I20100610000952 |
| Provider Name | Noel M Han |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508856659 PECOS PAC ID: 9335279710 Enrollment ID: I20100610000969 |
| Provider Name | Jeffery Lambert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841280617 PECOS PAC ID: 4183620016 Enrollment ID: I20100621000898 |
| Provider Name | James E Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356365324 PECOS PAC ID: 8921139163 Enrollment ID: I20100701000527 |
| Provider Name | Christopher K Robertson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629166517 PECOS PAC ID: 5698806883 Enrollment ID: I20100702000247 |
| Provider Name | Randall V Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942397849 PECOS PAC ID: 3577640697 Enrollment ID: I20100715000762 |
| Provider Name | Joel E Nachimson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922040633 PECOS PAC ID: 2062448012 Enrollment ID: I20101118001381 |
| Provider Name | Maninder S Guram |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1689671307 PECOS PAC ID: 1456343524 Enrollment ID: I20110429000024 |
| Provider Name | Henna M Malik |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1003099813 PECOS PAC ID: 4183800410 Enrollment ID: I20110520000146 |
| Provider Name | Jerry D Rouse |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1740223056 PECOS PAC ID: 5991701203 Enrollment ID: I20120517000132 |
| Provider Name | Ankur R Khosla |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1861760985 PECOS PAC ID: 3779723820 Enrollment ID: I20130712000504 |
| Provider Name | William L Yancey |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1396989067 PECOS PAC ID: 0244468882 Enrollment ID: I20140106001044 |
| Provider Name | Marcela Campo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1831390574 PECOS PAC ID: 4688790959 Enrollment ID: I20140821000429 |
| Provider Name | Nefertiti C Dupont |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1326105511 PECOS PAC ID: 4385724707 Enrollment ID: I20140905002266 |
| Provider Name | Andrea C Colburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356742068 PECOS PAC ID: 4183946536 Enrollment ID: I20141215000371 |
| Provider Name | Waqar M Haque |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1639494628 PECOS PAC ID: 0840506010 Enrollment ID: I20150902001730 |
| Provider Name | Stephen A Moore |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1972980670 PECOS PAC ID: 0840507315 Enrollment ID: I20150916000242 |
| Provider Name | Efthymios Gkotsoulias |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1346506631 PECOS PAC ID: 0941522163 Enrollment ID: I20160216001910 |
| Provider Name | Tamaura L Baughman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437520921 PECOS PAC ID: 4880993633 Enrollment ID: I20160428000822 |
| Provider Name | Erika E Goodson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366888950 PECOS PAC ID: 9335443290 Enrollment ID: I20160520000380 |
| Provider Name | Rebekah B Maymani |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1164716403 PECOS PAC ID: 2668763467 Enrollment ID: I20160627000905 |
| Provider Name | Bonnie J Martinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194141697 PECOS PAC ID: 2264703842 Enrollment ID: I20170731002142 |
| Provider Name | Jennifer L Ligon-gaston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780037861 PECOS PAC ID: 1052687548 Enrollment ID: I20171027002498 |
| Provider Name | Melissa K Wilkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922553510 PECOS PAC ID: 1557637964 Enrollment ID: I20171030000958 |
| Provider Name | Ginger L Mcmillian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306237664 PECOS PAC ID: 7517233828 Enrollment ID: I20171031002236 |
| Provider Name | Olivia O Antonello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609121680 PECOS PAC ID: 3375843535 Enrollment ID: I20171127000815 |
| Provider Name | Mary Kosco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457698730 PECOS PAC ID: 6406114388 Enrollment ID: I20171226000469 |
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