| Organization Name: | EAST TEXAS BORDER HEALTH CLINIC |
| NPI Number: | 1700134996 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARLA ROADCAP (CEO) |
| Mailing Address: | 502 E Rusk Marshall |
| State: | TX US |
| Postal Code: | 756703408 |
| Phone Number: | 9039273782 |
| Fax Number: | 9039271764 |
| NPI Enumeration Date: | 08/21/2012 |
| NPI Last Update Date: | 04/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |