Longevity Urgent Care PLLC
Organization Active NPI Family Medicine Physician · Krum, TX
NPI 1972889988 · NPPES record last updated Jan 28, 2016
Key facts
- NPI
- 1972889988
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- K7643 (TX)
- Legal business name
- LONGEVITY URGENT CARE PLLC
- Practice address
- 128 West McCart St
Ste B
Krum, TX 76249 - Phone
- (940) 390-9709
- Fax
- (940) 482-1775
- NPI assigned
- Oct 24, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Adrian C Jones, NP-C
- Title
- Nurse Practitioner
- Phone
- (940) 320-9709
Practitioners 1
-
Adrian Coy Jones, NP-C, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120104000383 | TX | Part B Supplier - Clinic/Group Practice | 2062688500 |
Receives reassigned benefits from 1 practitioner Practice locations: Krum, TX |
National Provider Directory
Locations
128 W McCart St
Ste B
Krum, TX 76249
Phone (940) 320-9709
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | K7643 | TX | Yes |
| General Practice Physician |
208D00000X | F1170 | TX | |
| Family Nurse Practitioner |
363LF0000X | 778411 | TX |
Addresses
Primary practice location
128 West McCart St
Ste B
Krum, TX 76249
Mailing address
PO Box 798
Krum, TX 76249-0798
Phone (940) 320-9709
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F1170 | Other | TX | TEXAS MEDICAL BOARD LIC. # |
| 778411 | Other | TX | TEXAS BOARD OF NURSING |
| K7643 | Other | TX | TEXAS MEDICAL BOARD LIC. # |
Other providers in Krum, TX
- Krum Isd
- KSM Dental Associates, PLLC
- Bruce Landers
- Lillian Miller Dental
- Jessica Renee Logar
- Bryan Scott Lovelace
- Lateah M Lucero
- Kelyn Luton
- Tony Luton
- Liane Elizabeth Macmillan
All providers in Krum, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.