Organization
LONGVIEW MEDICAL CENTER LP
Active
Other names
Longview Regional Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR PROVIDER ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
2901 N 4TH ST, LONGVIEW, TX 75605-5128
(903) 758-1818
(903) 758-5167
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
—
—
207L00000X
Anesthesiology Physician
—
—
363A00000X
Physician Assistant
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110839101
—
TX
05
—
110839104
—
TX
Enumeration date
05/03/2006
Last updated
07/28/2021
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