Provider Demographics
NPI:1922055425
Name:HONG-I SHEN, M.D., P.A.
Entity Type:Organization
Organization Name:HONG-I SHEN, M.D., P.A.
Other - Org Name:SHEN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG-I
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-247-4404
Mailing Address - Street 1:3100 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5139
Mailing Address - Country:US
Mailing Address - Phone:903-247-4404
Mailing Address - Fax:903-247-4408
Practice Address - Street 1:3100 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5139
Practice Address - Country:US
Practice Address - Phone:903-247-4404
Practice Address - Fax:903-247-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172138301Medicaid
TX00697VOtherGROUP NUMBER
TX00697VOtherBCBS GROUP NUMBER
TX172138302Medicaid