Organization
DIAGNOSTIC CLINIC OF LONGVIEW PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORA C REEVES (CREDENTIALING COORDINATOR)
(903) 291-6062
Entity
Organization
Contact information
Practice address
707 HOLLYBROOK DR, LONGVIEW, TX 75605-2410
(903) 757-6042
(903) 232-8226
Mailing address
707 HOLLYBROOK DR, LONGVIEW, TX 75605-2410
(903) 757-6042
(903) 232-8226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
TX
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
TX
207RI0011X
Interventional Cardiology Physician
—
—
207RI0200X
Infectious Disease Physician
—
TX
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
TX
207UN0901X
Nuclear Cardiology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130964302
—
TX
05
—
130964306
—
TX
05
—
130964307
—
TX
01
—
45D0482673
DME RR MEDICARE
TX
Enumeration date
09/06/2005
Last updated
02/05/2009
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