| Etmc First Physicians Clinic Jacksonville | |
|
203 Nacogdoches St Suite 280 Jacksonville TX 75766-2444 | |
| (903) 541-5396 | |
| (903) 541-5393 |
| Full Name | Etmc First Physicians Clinic Jacksonville |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 203 Nacogdoches St, Jacksonville, Texas |
| Authorized Official Name and Position | Jack R Endres (ADMINISTRATOR) |
| Authorized Official Contact | 9035415100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Etmc First Physicians Clinic Jacksonville 501 S Ragsdale St Administration Jacksonville TX 75766-2434 Ph: (903) 541-5100 | Etmc First Physicians Clinic Jacksonville 203 Nacogdoches St Suite 280 Jacksonville TX 75766-2444 Ph: (903) 541-5396 |
| NPI Number | 1821366170 |
|---|---|
| Provider Enumeration Date | 12/01/2011 |
| Last Update Date | 11/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821366170 | NPI | - | NPPES |
| 130612807 | Medicaid | TX | |
| 130612808 | Other | TX | THSTEPS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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