Provider Demographics
NPI:1467682567
Name:LONGVIEW REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:LONGVIEW REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:903-233-4771
Mailing Address - Street 1:2901 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5128
Mailing Address - Country:US
Mailing Address - Phone:903-233-4771
Mailing Address - Fax:903-242-3333
Practice Address - Street 1:2901 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5128
Practice Address - Country:US
Practice Address - Phone:903-233-4771
Practice Address - Fax:903-242-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81095282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital