Healthcare Provider Details

I. General information

NPI: 1104541390
Provider Name (Legal Business Name): PRIME CARE MANAGERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 TECHNOLOGY CTR
LONGVIEW TX
75605-2697
US

IV. Provider business mailing address

4002 TECHNOLOGY CTR
LONGVIEW TX
75605-2697
US

V. Phone/Fax

Practice location:
  • Phone: 903-247-0525
  • Fax: 903-230-2709
Mailing address:
  • Phone: 903-247-0525
  • Fax: 903-230-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS JEANETTE SCHAUBLIN
Title or Position: ACO COORDINATOR
Credential: LVN
Phone: 903-247-0525