Provider Demographics
NPI:1124296843
Name:HEALTH OPPORTUNITIES FOR THE PEOPLE OF EAST TEXAS, INC.
Entity type:Organization
Organization Name:HEALTH OPPORTUNITIES FOR THE PEOPLE OF EAST TEXAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DESTANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-591-8380
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-1584
Mailing Address - Country:US
Mailing Address - Phone:936-591-8380
Mailing Address - Fax:936-598-4499
Practice Address - Street 1:157 WALL STREET
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-5413
Practice Address - Country:US
Practice Address - Phone:936-248-4673
Practice Address - Fax:936-248-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221153163WG0000X
TX394931041C0700X
TX541217363LF0000X
TX562803363LF0000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190930101Medicaid
TX671883Medicare PIN