| 7872 Inc. | |
|
615 Clinic Dr Longview TX 75605-5172 | |
| (903) 212-3105 | |
| Not Available |
| Full Name | 7872 Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 615 Clinic Dr, Longview, Texas |
| Authorized Official Name and Position | Rupa Peddireddy (PRESIDENT) |
| Authorized Official Contact | 2143925974 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 7872 Inc. 2400 Sugar Creek Cir Longview TX 75605-2580 Ph: (214) 334-6831 | 7872 Inc. 615 Clinic Dr Longview TX 75605-5172 Ph: (903) 212-3105 |
| NPI Number | 1043576218 |
|---|---|
| Provider Enumeration Date | 04/02/2012 |
| Last Update Date | 09/16/2022 |
| Certification Date | 09/16/2022 |
| Medicare PECOS PAC ID | 8325209166 |
|---|---|
| Medicare Enrollment ID | O20120423000162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043576218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Rupa Peddireddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952515827 PECOS PAC ID: 2365598257 Enrollment ID: I20110927000657 |
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