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CAH451380-02 East Texas Medical Center Quitman (Terminated)
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Main Details
Name
East Texas Medical Center Quitman
Subdivision Name
ETMC FIRST PHYSICIANS CLINIC QUITMA
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH451380-02
Medicare Provider Number
451380
Outpatient Facility Provider Number
458852
Additional Details
Current Program Status
Terminated
Registration Date
10/28/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/19/2014
Last Recertification Date
11/6/2017
Termination Date
Termination Reason
4/1/2018
For-Profit conversion
Contacts
Authorizing Official
ETMC Quitman
Patrick Swindle, Administrator
(903) 763-6300
Primary Contact
ETMC Quitman
Kathryn Nicole Whitehead, Pharmacy Supervisor
(903) 763-6379
Addresses
Street Address
117 NORTH WINNSBORO ST.
ETMC FIRST PHYSICIANS CLINIC QUITMAN
QUITMAN, TX 75783-2144
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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