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CAH451380-03 East Texas Medical Center Quitman (Terminated)
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Main Details
Name
East Texas Medical Center Quitman
Subdivision Name
ETMC First Physicians Clinic Grand Saline
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH451380-03
Medicare Provider Number
451380
Outpatient Facility Provider Number
673444
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/19/2017
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
801 N Waldrip St
Grand Saline, TX 75140
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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