PREMIERE PEDIATRICS PLLC NPI 1124721410

NPI Information

  • NPI: 1124721410
  • Provider Name: PREMIERE PEDIATRICS PLLC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Address: 703 E MARSHALL AVE STE 4002
    LONGVIEW, TX
    ZIP 75601
  • Phone: (903) 315-3966

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NPI Details

PREMIERE PEDIATRICS PLLC is a pediatrics in Longview, TX. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PREMIERE PEDIATRICS PLLC NPI is 1124721410. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

703 E MARSHALL AVE STE 4002
LONGVIEW, TX
ZIP 75601-622
Phone: (903) 315-3966
Fax: (903) 230-0795

The provider's authorized official is Samantha Jayne Roworth-chaikin .
The authorized official title is Physician Owner and has the following contact phone number (903) 315-3966.

The enumeration date for this NPI number is 3/24/2023 and was last updated on 3/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerNo
2208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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