| |
3100 N 4th St Longview TX 75605-5139 | |
(903) 247-4404 | |
(903) 247-4408 |
Full Name | |
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Speciality | Family Medicine |
Location | 3100 N 4th St, Longview, Texas |
Authorized Official Name and Position | Hong-i Shen (PRESIDENT) |
Authorized Official Contact | 9032474404 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3100 N 4th St Longview TX 75605-5139 Ph: (903) 247-4404 | 3100 N 4th St Longview TX 75605-5139 Ph: (903) 247-4404 |
NPI Number | 1841370756 |
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Provider Enumeration Date | 10/16/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 2163428863 |
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Medicare Enrollment ID | O20061019000236 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841370756 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | K7894 (Texas) | Primary |
Provider Name | Hong-i Shen |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1700866969 PECOS PAC ID: 3870599574 Enrollment ID: I20100809001006 |
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