GENESIS PRIMECARE
NPI 1093186249
Clinic/Center - Federally Qualified Health Center (FQHC) in Texarkana, AR

Q: What is East Texas Border Health Clinic's NPI number?

The NPI number for East Texas Border Health Clinic is 1093186249. It was assigned to this organization in the NPPES registry on October 14, 2015. The provider is doing business as Genesis Primecare.

Q: What is East Texas Border Health Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since October 14, 2015CLIA Certified · 2 labs

1205 E 35TH ST, TEXARKANA, AR 71854(870) 216-0080(870) 216-0093 Get Directions Write a Review

NPPES record last updated: December 12, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 12, 2024, Jun 13, 2024, Aug 28, 2023 and 5 more (8 updates tracked since 2018).

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About Genesis Primecare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GENESIS PRIMECARE (NPI 1093186249) is a healthcare organization registered as a federally qualified health center (fqhc) in Texarkana, Arkansas and active in the NPI registry since October 2015. The organization holds 2 active CLIA laboratory certificates and lists Carla Roadcap, Ceo, as its authorized official.

NPPES Registry Identity

NPI1093186249

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameEAST TEXAS BORDER HEALTH CLINIC

Location Address1205 E 35TH STTexarkana, AR 71854-2746

Mailing AddressPo Box 1326Marshall, TX 75671-1326 · (903) 927-3782 · Fax (903) 927-1764

Phone(870) 216-0080

Fax(870) 216-0093

Organization SubpartNo

Authorized OfficialCarla RoadcapCeo · (903) 927-3782

Enumeration DateOctober 14, 2015

Last NPPES UpdateDecember 12, 20248 updates tracked since enumeration

NPPES CertifiedDecember 12, 2024

✔ NPI 1093186249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

Also ListedCounselorTaxonomy 101Y00000X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedPediatricsTaxonomy 208000000X

1205 E 35TH ST, Texarkana, AR 71854

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Other Names 1

Doing Business AsGenesis Primecare

Other Identifiers 2

Medicaid213389749AR

Medicaid356940201TX

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D2105446

Genesis Primecare East Texas Border Health · Texarkana, AR

Active · expires Nov 23, 2027

CLIA Number04D2105446

Laboratory TypeFederally Qualified Health Center

Certificate Effective DateNovember 24, 2025

Certificate Expiration DateNovember 23, 2027

Laboratory DirectorDr. Jeffory Beaty

Laboratory Phone(870) 216-0080

Laboratory LocationGenesis Primecare East Texas Border Health1205 East 35th Street, Texarkana, AR 71854

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 04D2161047

Genesis Primecare East Texas Border Health Clinic · Texarkana, AR

Active · expires Jan 23, 2027

CLIA Number04D2161047

Laboratory TypeFederally Qualified Health Center

Certificate Effective DateJanuary 24, 2025

Certificate Expiration DateJanuary 23, 2027

Laboratory DirectorDr. Jeffory Beaty

Laboratory Phone(870) 330-9200

Laboratory LocationGenesis Primecare East Texas Border Health Clinic4077 Jefferson Ave, Texarkana, AR 71854

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TOMMY CALDWELL

Nurse Practitioner (Family)