Provider Demographics
NPI:1992887384
Name:ANCOR HEALTH CENTER, PA
Entity type:Organization
Organization Name:ANCOR HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE 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 1:818 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5433
Mailing Address - Country:US
Mailing Address - Phone:903-236-8600
Mailing Address - Fax:903-236-7493
Practice Address - Street 1:818 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5433
Practice Address - Country:US
Practice Address - Phone:903-236-8600
Practice Address - Fax:903-236-7493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCOR HEALTH CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166395704Medicaid
TX166395702Medicaid
TX166395701Medicaid
00096XMedicare ID - Type Unspecified