EAST TEXAS BORDER HEALTH CLINIC NPI 1093186249

NPI Information

EAST TEXAS BORDER HEALTH CLINIC is a federally qualified health center (fqhc) clinic center in Texarkana, AR. EAST TEXAS BORDER HEALTH CLINIC NPI is 1093186249. The provider is registered as an organization entity type.
The provider Is Doing Business As Genesis Primecare.

The provider's business location address is:

1205 E 35TH ST
TEXARKANA, AR
ZIP 71854-746
Phone: (870) 216-0080
Fax: (870) 216-0093

The provider's authorized official is Carla Roadcap .
The authorized official title is Ceo and has the following contact phone number (903) 927-3782.

The CLIA number assigned to this NPI record is 04D2105446 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/14/2015 and was last updated on 8/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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