NPIMap

Individual provider Active NPI

Elizabeth Ann Heeb Tidwell, M.D.

  • Obstetrics & Gynecology Physician
  • Longview, TX
National Provider Identifier
1386023968
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
S1001 Issued in TX
Practice address
802 Medical Dr Ste 100
Longview, TX 75605-5207
Phone
(903) 757-6042
Fax
(903) 232-6060
NPI assigned
May 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X S1001 TX Primary

Addresses

Primary practice location

802 Medical Dr Ste 100
Longview, TX 75605-5207

Mailing address

802 Medical Dr Ste 100
Longview, TX 75605-5207
Phone (903) 757-6042

Other identifiers 1

IdentifierTypeStateIssuer
398365201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190615000140 TX Practitioner - Obstetrics/Gynecology 3476834573 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Missouri, Columbia School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Clinicians of East TexasGroup PAC ID 4789957440, 106 clinicians

Practice addresses (Care Compare)

802 Medical Cir
Suite 100
Longview, TX 75605-5207
Phone (903) 757-6042

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
S1001TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Longview Wellness Center Inc Obstetrics & Gynecology CurrentSince Sep 13, 2019 Accepting new patients
Longview Wellness Center, Inc Obstetrics & Gynecology Current Accepting new patients
Associated Clinicians of East Texas Obstetrics & Gynecology CurrentSince Jul 1, 2019 Accepting new patients
Longview Wellness Center Inc Obstetrics & Gynecology CurrentSince Sep 13, 2019 Accepting new patients
Longview Wellness Center Inc Obstetrics & Gynecology PastSince Jan 2, 2022 Accepting new patients
Longview Medical Center LP Obstetrics & Gynecology Past Accepting new patients

Locations

1107 E Marshall Ave
Longview, TX 75601
Phone (903) 212-4763

802 Medical Cir
Ste 100
Longview, TX 75605
Phone (903) 757-6042

1701 Pine Tree Rd
Longview, TX 75604
Phone (903) 295-5151

707 Hollybrook Dr
Longview, TX 75605
Phone (903) 232-8501

707 Hollybrook Dr
Ste 500
Longview, TX 75605
Phone (903) 232-8276

Interoperability endpoints

  • Direct secure messaging: elizabeth.tidwell.1@23550.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1386023968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 MEDICAL DR STE 100",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055207",
            "telephone_number": "903-757-6042",
            "fax_number": "903-232-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 MEDICAL DR STE 100",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055207",
            "telephone_number": "903-757-6042",
            "fax_number": "903-232-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "ELIZABETH",
        "middle_name": "ANN HEEB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-28",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "S1001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "398365201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.