Healthcare Provider Details

I. General information

NPI: 1336192640
Provider Name (Legal Business Name): LONGVIEW MEDICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 N 4TH ST
LONGVIEW TX
75605-5128
US

IV. Provider business mailing address

PO BOX 848144
DALLAS TX
75284-8144
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-1818
  • Fax: 903-758-5167
Mailing address:
  • Phone: 903-758-1818
  • Fax: 903-758-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000525
License Number StateTX

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565