| Twelve52 Clinic | |
|
2010 Gilmer Rd Ste 103a Longview TX 75604-2545 | |
| (903) 347-5483 | |
| Not Available |
| Full Name | Twelve52 Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2010 Gilmer Rd Ste 103a, Longview, Texas |
| Authorized Official Name and Position | Tameka Royal (NURSE PRACTITIONER) |
| Authorized Official Contact | 9033994521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Twelve52 Clinic Po Box 9711 Longview TX 75608-9711 Ph: () - | Twelve52 Clinic 2010 Gilmer Rd Ste 103a Longview TX 75604-2545 Ph: (903) 347-5483 |
| NPI Number | 1386210441 |
|---|---|
| Provider Enumeration Date | 05/31/2021 |
| Last Update Date | 09/17/2021 |
| Medicare PECOS PAC ID | 1951708288 |
|---|---|
| Medicare Enrollment ID | O20210929000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386210441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Tameka Lachell Royal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891190344 PECOS PAC ID: 0042530982 Enrollment ID: I20150518000801 |
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