Provider Demographics
NPI:1205861895
Name:LONGVIEW DIAGNOSTIC IMAGING, LTD
Entity Type:Organization
Organization Name:LONGVIEW DIAGNOSTIC IMAGING, LTD
Other - Org Name:OPEN IMAGING OF LONGVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-757-9596
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0100
Mailing Address - Country:US
Mailing Address - Phone:903-785-5421
Mailing Address - Fax:
Practice Address - Street 1:1010 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5534
Practice Address - Country:US
Practice Address - Phone:903-757-9596
Practice Address - Fax:903-757-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0289DCOtherBLUE CROSS BLUE SHIELD
LA1777609Medicaid
MS01024251Medicaid
CK8023Medicare ID - Type UnspecifiedRAILROAD
0289DCOtherBLUE CROSS BLUE SHIELD