ETMC PHYSICIAN GROUP INC. NPI 1104316322

NPI Information

  • NPI: 1104316322
  • Provider Name: ETMC PHYSICIAN GROUP INC.
  • Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
  • Entity Type: Organization
  • Doing Business As: UT HEALTH EAST TEXAS PHYSICIANS
  • CLIA Number: 45D0998103
  • Address: 203 NACOGDOCHES ST STE 150
    JACKSONVILLE, TX
    ZIP 75766
  • Phone: (903) 586-6289

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NPI Details

ETMC PHYSICIAN GROUP INC. is a durable medical equipment medical supplies in Jacksonville, TX. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. ETMC PHYSICIAN GROUP INC. NPI is 1104316322. The provider is registered as an organization entity type.
The provider Is Doing Business As Ut Health East Texas Physicians.

The provider's business location address is:

203 NACOGDOCHES ST STE 150
JACKSONVILLE, TX
ZIP 75766-453
Phone: (903) 586-6289

The provider's authorized official is Stephen C. Petrovich .
The authorized official title is Evp and has the following contact phone number (615) 296-3000.

The CLIA number assigned to this NPI record is 45D0998103 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 5/14/2018 and was last updated on 5/14/2018.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesYes

What is NPI?

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This page was last updated on: 11/21/2025

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