NPIMap

Organization Active NPI

Venous Laser Center of East Texas

  • Diagnostic Radiology Physician
  • Longview, TX
National Provider Identifier
1447208103
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
VENOUS LASER CENTER OF EAST TEXAS
Practice address
903 N 4TH St
Longview, TX 75601-5416
Phone
(903) 753-6500
Fax
(903) 247-0222
NPI assigned
May 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jerry Keaton, MDNPI 1699731836
Title
President
Phone
(903) 753-6500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

903 N 4TH St
Longview, TX 75601-5416

Mailing address

1602 Pine Tree Rd
Suite 3
Longview, TX 75604-3273
Phone (903) 759-8886

Other identifiers 1

IdentifierTypeStateIssuer
0049MUOtherTXBLUE CROSS BLUE SHIELD TX

National Provider Directory

National Provider Directory

Locations

1602 Pine Tree Rd
Ste 3
Longview, TX 75604

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447208103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 PINE TREE RD",
            "address_2": "SUITE 3",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756043273",
            "telephone_number": "903-759-8886",
            "fax_number": "903-247-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 N 4TH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015416",
            "telephone_number": "903-753-6500",
            "fax_number": "903-247-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENOUS LASER CENTER OF EAST TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEATON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-753-6500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TX",
            "identifier": "0049MU",
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.