LONGEVITY MEDICINE, PLLC – NPI #1962672204
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

LONGEVITY MEDICINE, PLLC is a provider located in BOLING-IAGO, TX. NPPES has assigned the NPI number 1962672204 to LONGEVITY MEDICINE, PLLC on March 03, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 208D00000X from the Health Care Provider Taxonomy code set, which is classified as General Practice.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LONGEVITY MEDICINE, PLLC below.

NPI Profile for
LONGEVITY MEDICINE, PLLC

NPI Number
1962672204
Enumeration Date

(more than 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LONGEVITY MEDICINE, PLLC
Primary location
120 RAILROAD STREET
BOLING-IAGO, TX 77420
Phone: (979) 657-4000 Fax:
Mailing address
PO BOX 700
BOLING, TX 77420-0700
Phone: (979) 657-4400 Fax: (979) 657-3800
Organization Subpart
No
Authorized Official
PETER ERICKSON
PRESIDENT/CEO
Phone: (979) 657-4400
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
208D00000X
- General Practice (Primary)
TX E5746

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.