Provider Demographics
NPI:1245733492
Name:SOMERS PEDIATRICS
Entity type:Organization
Organization Name:SOMERS PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-230-3311
Mailing Address - Street 1:PO BOX 5699
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608
Mailing Address - Country:US
Mailing Address - Phone:903-230-3311
Mailing Address - Fax:903-230-3312
Practice Address - Street 1:103 W. LOOP 281, SUITE 474
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-230-3311
Practice Address - Fax:903-230-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM96692080P0208X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206460203Medicaid