NPIMap

Organization Active NPI

Phynet, Inc.

  • Family Medicine Physician
  • Longview, TX
National Provider Identifier
1144245176
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYNET, INC.
Practice address
4002 Technology Ctr
Longview, TX 75605-2697
Phone
(903) 247-0484
Fax
(903) 247-0485
NPI assigned
Jul 12, 2006
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John D Ford
Title
Chief Executive Officer
Phone
(903) 247-0484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4002 Technology Ctr
Longview, TX 75605-2697

Mailing address

4002 Technology Ctr
Longview, TX 75605-2697
Phone (903) 247-0484

Other practice location 1

103 N Main St
Lindale, TX 75771-3115
Phone (903) 882-3194

Other practice location 2

307 W Upshur Ave
Gladewater, TX 75647-2121
Phone (903) 845-2159

Other practice location 3

1711 S Henderson Blvd Ste 300
Kilgore, TX 75662-3563
Phone (903) 988-0605

Other practice location 4

219 N Polk St
Jefferson, TX 75657-2131
Phone (903) 665-2600

Other practice location 5

402 N Kaufman St
Linden, TX 75563-5234
Phone (903) 756-5581

Other practice location 6

201 E 2nd
Hughes Springs, TX 75656-2597
Phone (903) 639-2004

Other practice location 7

3211 4th St
Longview, TX 75605-5145
Phone (903) 212-1012

Other practice location 8

800 N Hill St
Tatum, TX 75691-1740
Phone (903) 947-6300

Other practice location 9

123 N Main St
Lone Star, TX 75668-2226
Phone (903) 656-0633

Other identifiers 1

IdentifierTypeStateIssuer
159694203MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040729000674 TX Part B Supplier - Clinic/Group Practice 8527038298 Receives reassigned benefits from 26 practitioners
Practice locations: Tatum, TX; Longview, TX; Lone Star, TX; Linden, TX; Lindale, TX; Jefferson, TX; Hughes Springs, TX; Gladewater, TX…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0482516Phynet, Inc402 N Kaufman St, Linden, TX 75563Certificate of waiverMay 4, 2028
45D1024378Phynet, Inc201 E 2ND Street, Hughes Springs, TX 75656Certificate of waiverApr 24, 2028
45D2099711Phynet, Inc3211 N 4TH Street, Suite a, Longview, TX 75605Certificate of waiverJul 30, 2027
45D2259773Phynet, Inc103 N Main St, Lindale, TX 75771Certificate of waiverMay 10, 2028

National Provider Directory

National Provider Directory

Locations

1711 S Henderson Blvd
Ste 300
Kilgore, TX 75662
Phone (903) 983-1578

2019A S Henderson Blvd
Ste 4
Kilgore, TX 75662
Phone (903) 988-0605

3211 4th St
Longview, TX 75605
Phone (903) 212-1012

3211 4th St
#A
Longview, TX 75605
Phone (903) 297-6500

4025 E Southcross Blvd
#7S
San Antonio, TX 78222
Phone (210) 333-1255

323 S Fannin Ave
Tyler, TX 75702
Phone (903) 531-9835

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1144245176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 TECHNOLOGY CTR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052697",
            "telephone_number": "903-247-0484",
            "fax_number": "903-247-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 TECHNOLOGY CTR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052697",
            "telephone_number": "903-247-0484",
            "fax_number": "903-247-0485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 N Main St",
            "address_purpose": "LOCATION",
            "city": "Lindale",
            "state": "TX",
            "postal_code": "757713115",
            "country_code": "US",
            "telephone_number": "903-882-3194",
            "fax_number": "903-882-7405",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "307 W Upshur Ave",
            "address_purpose": "LOCATION",
            "city": "Gladewater",
            "state": "TX",
            "postal_code": "756472121",
            "country_code": "US",
            "telephone_number": "903-845-2159",
            "fax_number": "903-845-5451",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 S Henderson Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Kilgore",
            "state": "TX",
            "postal_code": "756623563",
            "country_code": "US",
            "telephone_number": "903-988-0605",
            "fax_number": "903-988-9804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "219 N Polk St",
            "address_purpose": "LOCATION",
            "city": "Jefferson",
            "state": "TX",
            "postal_code": "756572131",
            "country_code": "US",
            "telephone_number": "903-665-2600",
            "fax_number": "903-665-2608",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 N Kaufman St",
            "address_purpose": "LOCATION",
            "city": "Linden",
            "state": "TX",
            "postal_code": "755635234",
            "country_code": "US",
            "telephone_number": "903-756-5581",
            "fax_number": "903-756-5005",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 E 2nd",
            "address_purpose": "LOCATION",
            "city": "Hughes Springs",
            "state": "TX",
            "postal_code": "756562597",
            "country_code": "US",
            "telephone_number": "903-639-2004",
            "fax_number": "903-665-2608",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3211 4th St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756055145",
            "country_code": "US",
            "telephone_number": "903-212-1012",
            "fax_number": "903-212-1020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 N Hill St",
            "address_purpose": "LOCATION",
            "city": "Tatum",
            "state": "TX",
            "postal_code": "756911740",
            "country_code": "US",
            "telephone_number": "903-947-6300",
            "fax_number": "903-947-2408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "123 N Main St",
            "address_purpose": "LOCATION",
            "city": "Lone Star",
            "state": "TX",
            "postal_code": "756682226",
            "country_code": "US",
            "telephone_number": "903-656-0633",
            "fax_number": "903-656-0636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYNET, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-06-08",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "903-247-0484"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159694203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.