Provider Demographics
NPI:1952946428
Name:ANCOR HEALTH CENTER, PA
Entity Type:Organization
Organization Name:ANCOR HEALTH CENTER, PA
Other - Org Name:SHINING STAR PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-985-8110
Mailing Address - Street 1:2304 JUDSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4675
Mailing Address - Country:US
Mailing Address - Phone:903-212-6060
Mailing Address - Fax:903-212-4466
Practice Address - Street 1:2304 JUDSON RD STE D
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4675
Practice Address - Country:US
Practice Address - Phone:903-212-6060
Practice Address - Fax:903-212-4466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCOR HEALTH CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-08
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty