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General NPI Number Information
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NPI Number | 1639673361
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Entity Type | Organization
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Legal Business Name | LONGVIEW WALK-IN CLINIC
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 624 MAPLE AVE
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City | GLADEWATER
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State | TX
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Zip | 75647-4826
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Country | US
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Telephone | 903-331-6987
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Fax |
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Provider Business Mailing Address
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Address Line | 624 MAPLE AVE
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City | GLADEWATER
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State | TX
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Zip | 75647-4826
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Country | US
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Telephone | 903-331-6987
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. PATRICIA ROSE GRIFFIN
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Credential | FNP-C
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Telephone | 903-331-6987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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