Ancor Health Center, PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ANCOR HEALTH CENTER, PA

Doing business as

Shining Star Pediatrics

Practice address

2304 Judson Rd Ste D
Longview, TX 75605-4675

Phone

(903) 212-6060

Fax

(903) 212-4466

NPI assigned

Nov 8, 2019

Last updated

Nov 14, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

ANCOR HEALTH CENTER PAAs reported in NPPES

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

Authorized official

Name

Earlene Cook

Title

Office Manager

Phone

(903) 985-8110

Specialties & licenses 1

Addresses

Other names 1

• SHINING STAR PEDIATRICS Doing business as

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

CLIA laboratory certificates

Part of

Ancor Health Center PA

Locations

Practitioners 2

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.

• Kristi Bengtson Bagnell, MD

  • Pediatrics Physician
  • Longview, TX
  • NPI 1841444692
  NPD
• Christopher E Ihionkhan, M.D.

  • Pediatrics Physician
  • Longview, TX
  • NPI 1407851249
  NPD

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573689600000",
    "number": "1952946428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 JUDSON RD STE D",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756054675",
            "telephone_number": "903-212-6060",
            "fax_number": "903-212-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 JUDSON RD STE D",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756054675",
            "telephone_number": "903-212-6060",
            "fax_number": "903-212-4466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2403 Judson Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756054639",
            "country_code": "US",
            "telephone_number": "903-212-6060",
            "fax_number": "903-212-4466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANCOR HEALTH CENTER, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANCOR HEALTH CENTER PA",
        "enumeration_date": "2019-11-08",
        "last_updated": "2019-11-14",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "EARLENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "903-985-8110"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHINING STAR PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• American Recovery Clinic LLC
• Krishan Amin
• Amkm Psychcare LLC
• Amwallace, LLC (August Wallace Eyecare Associates)
• Anchored Hope and Healing, PLLC
• Ancor Health Center, PA
• Joseph Anders
• Alesia Lesha Anderson
• Charity Michal Anderson, LPC
• Jessica Anderson, LPC-ASSOCIATE

• Specialist in Longview, TX
• Providers in Longview, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.