| |
705 E Marshall Ave Ste 3000 Longview TX 75601-5661 | |
(903) 315-2700 | |
(903) 236-2575 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 705 E Marshall Ave Ste 3000, Longview, Texas |
Authorized Official Name and Position | Kim Dale Nesvig (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 9032340776 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2709 Longview TX 75606-2709 Ph: (903) 234-0776 | 705 E Marshall Ave Ste 3000 Longview TX 75601-5661 Ph: (903) 315-2700 |
NPI Number | 1891280277 |
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Provider Enumeration Date | 06/27/2018 |
Last Update Date | 06/27/2018 |
Identifier | Type | State | Issuer |
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1891280277 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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