OrganizationActive
East Texas Out-Patient PLLC
NPI 1417511593 · Family Medicine Physician · Edgewood, TX
Provider details
- NPI number
- 1417511593
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jimmy Dailey, Owner(903) 567-1910
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
116 N Houston St
Edgewood, TX 75117-1555
Phone: (903) 962-3419
Fax: (903) 385-3340
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 76
Canton, TX 75103-0076
Registry dates
- Enumerated
- 2019-04-24
- Last updated
- 2025-07-01
- Certified
- 2025-07-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.