EAST TEXAS OUT-PATIENT PLLC - NPI 1417511593 - Family Medicine in Edgewood, TX

Q: What is East Texas Out-Patient PLLC's NPI number?

The NPI number for East Texas Out-Patient PLLC is 1417511593. It was assigned to this organization in the NPPES registry on April 24, 2019.

Q: What is East Texas Out-Patient PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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About East Texas Out-patient Pllc NPPES

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

EAST TEXAS OUT-PATIENT PLLC (NPI 1417511593) is a healthcare organization registered as a family medicine in Edgewood, Texas and active in the NPI registry since April 2019. The organization holds a CLIA Waiver certificate valid through October 9, 2027 and lists Jimmy W Dailey, Owner, as its authorized official.

NPPES Registry Identity

NPI1417511593

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameEAST TEXAS OUT-PATIENT PLLC

Location Address116 N HOUSTON STEdgewood, TX 75117-1555

Mailing AddressPo Box 76Canton, TX 75103-0076 · (903) 962-3419 · Fax (903) 962-3635

Phone(903) 962-3419

Fax(903) 385-3340

Organization SubpartNo

Authorized OfficialJimmy W DaileyOwner · (903) 567-1910

Enumeration DateApril 24, 2019

Last NPPES UpdateJuly 1, 20254 updates tracked since enumeration

NPPES CertifiedJuly 1, 2025

✔ NPI 1417511593 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

116 N HOUSTON ST, Edgewood, TX 75117

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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 45D2173375

East Texas Out-Patient, PLLC · Edgewood, TX

Active · expires Oct 9, 2027

CLIA Number45D2173375

Laboratory TypePhysician Office

Certificate Effective DateOctober 10, 2025

Certificate Expiration DateOctober 9, 2027

Laboratory DirectorJimmy W. Dailey

Laboratory Phone(903) 962-3419

Laboratory LocationEast Texas Out-Patient, PLLC116 N Houston Street, Edgewood, TX 75117

CLIA data matches this NPI record on: Address Name Phone

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

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Texas Out-Patient PLLC's NPI number?

The NPI number for East Texas Out-Patient PLLC is 1417511593. It was assigned to this organization in the NPPES registry on April 24, 2019.

Where is East Texas Out-Patient PLLC located?

East Texas Out-Patient PLLC is located at 116 N Houston St, Edgewood, TX 75117. The listed phone number is (903) 962-3419.

What is East Texas Out-Patient PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does East Texas Out-Patient PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2173375) is associated with this NPI, valid through October 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does East Texas Out-Patient PLLC accept?

Health plans from Blue Cross and Blue Shield of Texas list East Texas Out-Patient PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for East Texas Out-Patient PLLC was last updated on July 1, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.