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General NPI Number Information
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NPI Number | 1336935857
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Entity Type | Organization
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Legal Business Name | LUCKYCHARM PRIMARY CARE PLLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 3521 N FOURTH STREET, SUITE 100
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City | LONGVIEW
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State | TX
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Zip | 75605
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Country | US
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Telephone | 903-448-2273
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Fax | 773-825-8352
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Provider Business Mailing Address
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Address Line | 2309 GILMER RD STE 101
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City | LONGVIEW
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State | TX
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Zip | 75604-2133
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Country | US
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Telephone | 903-488-2273
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Fax | 773-825-8352
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Authorized Official
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Title or Position | OWNER
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Name | DR. UCHENNE EVANS MBARAONYE
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Credential | DO
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Telephone | 937-554-8570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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