Healthcare Provider Details

I. General information

NPI: 1134817950
Provider Name (Legal Business Name): SOMERS MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/28/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 NORTH FOURTH STREET SUITE B
LONGVIEW TX
75605
US

IV. Provider business mailing address

PO BOX 5699
LONGVIEW TX
75608-5699
US

V. Phone/Fax

Practice location:
  • Phone: 903-230-3311
  • Fax: 903-230-3312
Mailing address:
  • Phone:
  • Fax: 903-230-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA SOMERS
Title or Position: CEO
Credential: MD
Phone: 903-230-3311