LONGVIEW PHYSICIANS SURGICAL CENTER
Ambulatory Health at 4 St, Longview, TX

License number
Texas 8064
Category
Ambulatory Health
Type
Ambulatory Surgical
Owner
Name: MS. JACINDA MICHEAL BENTON
Title: ADMINISTRATOR
Phone: (903) 248-9240
Address
Address
1404 N 4Th St, Longview, TX 75601
National Provider ID: 1194708024
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LONGVIEW PHYSICIANS' SURGICAL CENTER, LLC

Longview, TX

Status:
Inactive
Doing business as:
Longview Physicians' Surgical Center, LLC
Registration:
Nov 5, 2001
Addresses:
1601 Pineridge St, Longview, TX 75604 (Mailing)
1400 N 4 St, Longview, TX 75601
State ID:
0800025438
Business type:
Domestic Limited Liability Company (LLC)
Members:
Andrei C Gasic MEMBER, Member, inactive, 4727 Mccann Rd, Longview, TX 75605,Johnasan M Gregory MEMBER, Member, inactive, 1400 N 4 St, Longview, TX 75601,Wade W. Whitmer Member, inactive,...
Agent:
Bert E Sharp,1601 Pineridge, Longview, TX 75604 (Physical)
TIN:
32003956854

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