| The Beverly Clinic | |
|
103a Woodbine Pl Longview TX 75601-2912 | |
| (903) 212-7788 | |
| Not Available |
| Full Name | The Beverly Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 103a Woodbine Pl, Longview, Texas |
| Authorized Official Name and Position | Daytral Brown (NURSE PRACTITIONER) |
| Authorized Official Contact | 9032127788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Beverly Clinic Po Box 883 Longview TX 75606-0883 Ph: (903) 212-7788 | The Beverly Clinic 103a Woodbine Pl Longview TX 75601-2912 Ph: (903) 212-7788 |
| NPI Number | 1609382209 |
|---|---|
| Provider Enumeration Date | 12/18/2017 |
| Last Update Date | 12/18/2017 |
| Medicare PECOS PAC ID | 2668732009 |
|---|---|
| Medicare Enrollment ID | O20180205000940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609382209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | AP120067 (Texas) | Primary |
| Provider Name | Daytral Matasha Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154629798 PECOS PAC ID: 8123257086 Enrollment ID: I20180205001060 |
| Provider Name | Cassandra L Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447813449 PECOS PAC ID: 8123361540 Enrollment ID: I20190528000667 |
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