Provider Demographics
NPI:1588092472
Name:EAST TEXAS BORDER HEALTH CLINIC
Entity type:Organization
Organization Name:EAST TEXAS BORDER HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROADCAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-927-3782
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1326
Mailing Address - Country:US
Mailing Address - Phone:903-927-3782
Mailing Address - Fax:903-472-4577
Practice Address - Street 1:401 N GROVE STREET
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3255
Practice Address - Country:US
Practice Address - Phone:903-665-8453
Practice Address - Fax:903-665-8496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST TEXAS BORDER HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-31
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)