Etmc Physician Group Inc.
NPI 1609382662ActiveOrganization· Internal Medicine, Cardiovascular Disease· Tyler, TX
Internal Medicine, Cardiovascular Disease in Tyler, Texas, registered in NPPES in December 2017, part of Ahs East Texas Health System, LLC. The authorized official on file is Stephen C. Petrovich, Evp And Secretary. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1609382662 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Ahs East Texas Health System, LLC |
| NPI issued | Dec 28, 2017 |
| Last updated in NPPES | Oct 9, 2020 |
| Certified by provider | Oct 9, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine, Cardiovascular Disease Primary | 207RC0000X | — | — |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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