| |
1107 E Marshall Ave Bldg 2 Longview TX 75601-5602 | |
(903) 758-2610 | |
(903) 758-7081 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1107 E Marshall Ave Bldg 2, Longview, Texas |
Authorized Official Name and Position | Timothy Chad Jones (CEO) |
Authorized Official Contact | 9037582610 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1107 E Marshall Ave Longview TX 75601-5602 Ph: (903) 758-2610 | 1107 E Marshall Ave Bldg 2 Longview TX 75601-5602 Ph: (903) 758-2610 |
NPI Number | 1518486380 |
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Provider Enumeration Date | 09/13/2017 |
Last Update Date | 10/01/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518486380 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Texas) | Primary |
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