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425 N Fredonia St Longview TX 75601-6464 | |
(903) 758-2610 | |
(903) 758-7081 |
Full Name | |
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Speciality | Clinic/Center |
Location | 425 N Fredonia St, Longview, Texas |
Authorized Official Name and Position | Timothy Chad Jones (CEO) |
Authorized Official Contact | 9037582610 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1107 E Marshall Ave Longview TX 75601-5602 Ph: (903) 758-2610 | 425 N Fredonia St Longview TX 75601-6464 Ph: (903) 758-2610 |
NPI Number | 1093491243 |
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Provider Enumeration Date | 06/23/2023 |
Last Update Date | 01/15/2025 |
Medicare PECOS PAC ID | 1254367766 |
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Medicare Enrollment ID | O20230901002640 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093491243 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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