Basic Information
| Provider Information | |||||||||
| NPI: | 1154400265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST TEXAS UROLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 E MARSHALL AVE | ||||||||
| Address2: | SUITE 5008 | ||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756015500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037577871 | ||||||||
| FaxNumber: | 9037532479 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 E MARSHALL AVE | ||||||||
| Address2: | SUITE 5008 | ||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756015500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037577871 | ||||||||
| FaxNumber: | 9037532479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9037577871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.