Provider Demographics
NPI:1639673361
Name:LONGVIEW WALK-IN CLINIC
Entity Type:Organization
Organization Name:LONGVIEW WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:903-331-6987
Mailing Address - Street 1:624 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-4826
Mailing Address - Country:US
Mailing Address - Phone:903-331-6987
Mailing Address - Fax:
Practice Address - Street 1:624 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-4826
Practice Address - Country:US
Practice Address - Phone:903-331-6987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care