Provider Demographics
NPI:1679794630
Name:EAST TEXAS CLINIC ASSOCIATION
Entity type:Organization
Organization Name:EAST TEXAS CLINIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-897-5684
Mailing Address - Street 1:101 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:TX
Mailing Address - Zip Code:75568-5870
Mailing Address - Country:US
Mailing Address - Phone:903-897-5684
Mailing Address - Fax:903-897-5339
Practice Address - Street 1:101 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:TX
Practice Address - Zip Code:75568-5870
Practice Address - Country:US
Practice Address - Phone:903-897-5684
Practice Address - Fax:903-897-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty