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Organization
REGIONAL CLINICS OF LONGVIEW
Active
Organization
REGIONAL CLINICS OF LONGVIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR PROV ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
709 HOLLYBROOK DR STE 2301, LONGVIEW, TX 75605-2412
(903) 757-5804
(903) 232-2888
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7000
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207VG0400X
Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
208000000X
Pediatrics Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195792002
—
TX
Enumeration date
08/09/2007
Last updated
04/21/2022
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