Provider Demographics
NPI:1447451406
Name:ASSOCIATED CLINICIANS OF EAST TEXAS
Entity type:Organization
Organization Name:ASSOCIATED CLINICIANS OF EAST TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-232-8501
Mailing Address - Street 1:709 HOLLYBROOK DR
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2411
Mailing Address - Country:US
Mailing Address - Phone:903-757-6042
Mailing Address - Fax:
Practice Address - Street 1:709 HOLLYBROOK DR
Practice Address - Street 2:SUITE 4500
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2411
Practice Address - Country:US
Practice Address - Phone:903-291-6030
Practice Address - Fax:903-291-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21518261QI0500X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty