Longview Wellness Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Longview, TX
NPI 1336788355 · NPPES record last updated Aug 20, 2026
Key facts
- NPI
- 1336788355
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LONGVIEW WELLNESS CENTER, INC.
- Practice address
- 425 N Fredonia St
Longview, TX 75601-6464 - Phone
- (903) 758-2610
- Fax
- (903) 758-7081
- NPI assigned
- Dec 23, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- LONGVIEW WELLNESS CENTER, INC.
Authorized official
- Name
- Timothy Chad Jones
- Title
- Chief Executive Officer
- Phone
- (903) 758-2610
Owners & managing parties with NPI records 16
Owned or controlled facilities with NPI records 9
Other NPIs on the same Medicare enrollment 27
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 27
Facilities with the same owner 9
Practitioners 28
-
Charlene Carter, O.D.
-
Felicia Kaye Coleman, ANP-BC, PMHNP-BC
-
John H Fields, PA
-
Jaclyn P Gilliam, CNM
-
Marcy Hall, FNP
-
Janet L. Kelley, MD
-
Sylyna G Kennedy, RN, CNM
-
Athena Lynn Manning, LPC
-
Christopher Norman Mason, M.D.
-
Monica Gale Mason, FNP-C
-
Roy Alan McClintock, M.D.
-
Vanessa Renee Neiman, M.D.
-
Kelly Denise Royce, APRN, CNM
-
John Shum, MD
-
Tracy Hunter Taylor, APRN, PMHNP-BC
-
Meliana Amazan Tiphete, APRN, FNP
-
Eleazar Vera Jr., MD
-
Ramon G. Villafria, M.D.
-
Arlene Faye Roberts, RN,MSN,CFNP
-
Sandra Aguilar, APRN
-
Annmarie McRena Ledley, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2187114 | Longview Wellness Center, Inc | Provider-performed microscopy | Jun 24, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 451113
- Legal name
- LONGVIEW WELLNESS CENTER INC
- Doing business as
- WELLNESS POINTE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 1, 2020
- Last certification
- Jul 1, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Aug 29, 1997 in TX
- Enrollment address
- 705 E Marshall Ave
Ste 3000
Longview, TX 75601-5661
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| William Womack |
Corporate Officer |
May 16, 2024 | 100% |
| W-2 Managing Employee |
May 16, 2024 | 100% | |
| Terrie Mogavero |
W-2 Managing Employee |
Nov 19, 2012 | 100% |
| Allen Lizza |
Corporate Director |
Jan 1, 2023 | 100% |
| Longview Wellness Center Inc |
5% Or Greater Indirect Ownership Interest | Aug 6, 2013 | 100% |
| Operational/Managerial Control | Aug 6, 2013 | 100% | |
| Francisco Rojas |
Corporate Director |
Jun 20, 2024 | 100% |
| Berenda Mathis |
Corporate Director |
Jan 1, 2023 | 100% |
| Anthony Brooks |
Corporate Director |
Mar 1, 2022 | 100% |
| Rosita Peralta |
Corporate Director |
May 16, 2024 | 100% |
| W-2 Managing Employee |
May 16, 2024 | 100% | |
| Timothy C Jones |
5% Or Greater Indirect Ownership Interest |
Aug 6, 2013 | 100% |
| Corporate Officer |
Aug 6, 2013 | 100% | |
| W-2 Managing Employee |
Aug 6, 2013 | 100% | |
| Operational/Managerial Control |
Aug 6, 2013 | 100% | |
| Ingrid Self |
Corporate Director |
Jan 1, 2022 | 100% |
| Mary a Hagenbucher |
Corporate Director |
Jan 1, 2022 | 100% |
| Susan B Warford |
Corporate Officer |
Jun 16, 2018 | 100% |
| W-2 Managing Employee |
Jun 16, 2018 | 100% | |
| Operational/Managerial Control |
Jun 16, 2018 | 100% | |
| Kent Phillips |
Corporate Director |
Jun 18, 2019 | 100% |
| Brad Osburg |
Corporate Director |
Jan 1, 2020 | 100% |
| Matt Tooker |
Corporate Director |
Jan 1, 2022 | 100% |
| Donna Habinc |
Corporate Director |
Jan 16, 2020 | 100% |
| Valerie Baxter |
Corporate Director |
Sep 20, 1972 | 100% |
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Wellness Pointe |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 6, 2013 Aug 6, 2013 |
| Wellness Pointe |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 6, 2013 |
| Wellness Pointe |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 6, 2013 |
| Wellness Pointe |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 6, 2013 Feb 1, 2021 |
| Wellness Pointe |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 4, 2022 |
| Longview Wellness Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 21, 2023 |
| Wellness Pointe |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 6, 2013 |
| Wellness Pointe |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 11, 2025 |
| Wellness Pointe |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 11, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050714001046 | TX | Part B Supplier - Clinic/Group Practice | 1254367766 |
Receives reassigned benefits from 130 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Longview, TX; Mount Pleasant, TX; Tyler, TX; Gilmer, TX; Kilgore, TX |
| O20200617001747 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 1254367766 | Practice locations: Longview, TX |
National Provider Directory
- Tax ID family
- Longview Wellness Center Inc
- Part of
- Longview Wellness Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Family Medicine Physician |
207Q00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| General Practice Physician |
208D00000X | |||
| Case Management Agency | 251B00000X | |||
| Ambulatory Family Planning Facility | 261QA0005X | |||
| Non-Surgical Family Planning Clinic/Center | 261QF0050X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Primary Care Clinic/Center | 261QP2300X |
Addresses
Primary practice location
425 N Fredonia St
Longview, TX 75601-6464
Mailing address
1107 E Marshall Ave
Longview, TX 75601-5602
Phone (903) 758-2610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 183824501 | Medicaid | TX |
Other names
- Wellness Pointe
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | robert.carson@wp.medallies | Direct |
Other providers in Longview, TX
- Longview Wellness Center Inc
- Longview Wellness Center Inc
- Longview Wellness Center, Inc
- Longview Wellness Center, Inc
- Longview Wellness Center, Inc
- Longview Wellness Center, Inc.
- Lauren Anne Looney
- Evelyn Renee Loose
- Leslie A Lope
- Destinee Snow Lopez
All providers in Longview, TX · Federally Qualified Health Center (FQHC) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.