Healthcare Provider Details

I. General information

NPI: 1902930589
Provider Name (Legal Business Name): LONGVIEW EMERGENCY MEDICINE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S WASHINGTON AVE
MARSHALL TX
75670-5336
US

IV. Provider business mailing address

PO BOX 24006
FORT WORTH TX
76124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 903-927-6000
  • Fax:
Mailing address:
  • Phone: 817-451-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. STANLEY D UPCHURCH
Title or Position: PRESIDENT
Credential: MD
Phone: 903-927-6000