Organization Name: | MEMORIAL MEDICAL CENTER OF EAST TEXAS |
NPI Number: | 1538114442 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FONDA R SULLIVAN (INSURANCE SUPERVISOR) |
Mailing Address: | 1201 W Frank Ave Lufkin |
State: | TX US |
Postal Code: | 759043357 |
Phone Number: | 9366313474 |
Fax Number: | 9366313475 |
NPI Enumeration Date: | 05/23/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G4097 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |