| Jefferson Life Center | |
|
219 N Polk St Jefferson TX 75657-2131 | |
| (903) 247-0484 | |
| (903) 247-0485 |
| Full Name | Jefferson Life Center |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 219 N Polk St, Jefferson, Texas |
| Authorized Official Name and Position | John Ford (PRESIDENT) |
| Authorized Official Contact | 9032470484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Life Center 4002 Technology Ctr Longview TX 75605-2697 Ph: (903) 247-0484 | Jefferson Life Center 219 N Polk St Jefferson TX 75657-2131 Ph: (903) 247-0484 |
| NPI Number | 1598093239 |
|---|---|
| Provider Enumeration Date | 11/18/2009 |
| Last Update Date | 03/19/2025 |
| Certification Date | 03/19/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598093239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
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