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General NPI Number Information
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NPI Number | 1801015615
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Entity Type | Organization
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Legal Business Name | LONGVIEW EMERGENCY MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 E MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75601-5580
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Country | US
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Telephone | 372-739-3710
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Fax |
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Provider Business Mailing Address
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Address Line | 700 EAST MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75601
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Country | US
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Telephone | 372-739-3710
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | JOHN DIPASQUALE
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Credential | M.D.
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Telephone | 903-315-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA05156
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License Number State | TX
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