Medeval, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

L8691 Issued in TX

Legal business name

MEDEVAL, LLC

Practice address

4920 Elizabeth St
Texarkana, TX 75503-2912

Phone

(903) 792-3812

NPI assigned

May 2, 2012

Organization subpart

No

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

Authorized official

Name

Dewitt Charles Fortenberry, MDNPI 1114960473

Title

Medical Director

Phone

(301) 641-5512

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dewitt Charles Fortenberry, MD

  • General Practice Physician
  • Texarkana, TX
  • NPI 1114960473
  Medicare reassignment NPD Authorized official
• Jenisa Johnson-Keener

  • Family Nurse Practitioner
  • Texarkana, TX
  • NPI 1962119586
  Medicare reassignment NPD
• Anne Higgins

  • Family Nurse Practitioner
  • Texarkana, AR
  • NPI 1801291901

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694908800000",
    "number": "1740548346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 WESTLAKE RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755010006",
            "telephone_number": "903-293-7093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 ELIZABETH ST",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032912",
            "telephone_number": "903-792-3812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "116 Westlake Rd",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755010006",
            "country_code": "US",
            "telephone_number": "903-293-7093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDEVAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2023-09-17",
        "certification_date": "2023-09-17",
        "status": "A",
        "authorized_official_last_name": "FORTENBERRY",
        "authorized_official_first_name": "DEWITT",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-641-5512",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": "L8691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joyce Ann McMurry, APRN
• Jessica Rene McWhorter
• Lindsay Michaela Meador, COTA
• Meadow Bridge Counseling LLC
• Med Southwest, PLLC
• Medical Center Medical Group
• Medical Investments of Texarkana LLC
• Medical Specialists of Texarkana
• Charles L Melton, M.D.
• Kiplan Trey Menefee, M.D.

• General Practice Physician in Texarkana, TX
• Providers in Texarkana, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.