Provider Demographics
NPI:1831406842
Name:E REMENCHIK MD PLLC
Entity type:Organization
Organization Name:E REMENCHIK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:REMENCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-553-0353
Mailing Address - Street 1:717 N 4TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5438
Mailing Address - Country:US
Mailing Address - Phone:903-758-0020
Mailing Address - Fax:903-758-0067
Practice Address - Street 1:717 N 4TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5438
Practice Address - Country:US
Practice Address - Phone:903-758-0020
Practice Address - Fax:903-758-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218907801Medicaid
TXB25869Medicare UPIN
TX218907801Medicaid