Basic Information
| Provider Information | |||||||||
| NPI: | 1366743643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ETMC FIRST PHYSICIANS CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 OLYMPIC PLAZA CIR STE 600 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963844 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 OLYMPIC PLAZA CIR STE 600 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2010 | ||||||||
| LastUpdateDate: | 11/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGEMENT SERVICE OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 9035963588 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 714451 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.