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NPI Code Detail

MEDICARE: CLINICAL PARTNERS PA - JASPER

MEDICARE: CLINICAL PARTNERS PA - JASPER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1104855808
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICAL PARTNERS PA - JASPER
Provider Business Mailing Address
First Line : PO BOX 5188
Second Line :
City : LONGVIEW
State : TX
Zip : 75608-5188
Country : US
Telephone Number : 903-663-3600
Fax Number : 866-777-9502
Provider Business Practice Location Address
First Line : 1275 MARVIN HANCOCK DR
Second Line :
City : JASPER
State : TX
Zip : 75951-4935
Country : US
Telephone Number : 903-663-3600
Fax Number : 866-777-9502
Authorized Official
Title or Position : OWNER
Name : HAROLD LEE BOLNICK
Credential : M.D.
Telephone Number : 903-261-7297
Provider Enumeration Date : 07/03/2006
Last Update Date : 08/22/2020

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Directions to “CLINICAL PARTNERS PA - JASPER ” Practice Location

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