NPIMap

Organization Active NPI

Longevity Medicine, PLLC

  • General Practice Physician
  • Boling, TX
National Provider Identifier
1962672204
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
E5746 Issued in TX
Legal business name
LONGEVITY MEDICINE, PLLC
Practice address
120 Railroad Street
Boling, TX 77420
Phone
(979) 657-4000
NPI assigned
Mar 3, 2008
Last updated
Mar 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Authorized official

Name
Peter Erickson, M.D.NPI 1902020332
Title
President/Ceo
Phone
(979) 657-4400

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
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X E5746 TX Primary

Addresses

Primary practice location

120 Railroad Street
Boling, TX 77420

Mailing address

PO Box 700
Boling, TX 77420-0700
Phone (979) 657-4400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1962672204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700",
            "city": "BOLING",
            "state": "TX",
            "postal_code": "774200700",
            "telephone_number": "979-657-4400",
            "fax_number": "979-657-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 RAILROAD STREET",
            "city": "BOLING",
            "state": "TX",
            "postal_code": "77420",
            "telephone_number": "979-657-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "979-657-4400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": "E5746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boling, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.