Kilgore Life Center is a Health Service Clinic/Center (organization) practicing in Kilgore, Texas. The National Provider Identifier (NPI) is #1093982290, which was assigned on May 15, 2008, and the registration record was last updated on September 2, 2025. The practitioner's main practice location is at 1711 S Henderson Blvd Ste 300, Kilgore, TX 75662-3563; the contact telephone number is 9039842145, and the fax number is 9039848361. The primary taxonomy of Kilgore Life Center is Health Service Clinic/Center (261QH0100X), with specialization in Health Service. The authorized official for Kilgore Life Center is Mr. John D. Ford (President).
| NPI | 1093982290 |
| Entity Type | Organization |
| Organization Name | KILGORE LIFE CENTER |
| Provider Name | KILGORE LIFE CENTER |
| Practice Address |
1711 S Henderson Blvd Ste 300 Kilgore TX 75662-3563 |
| Practice Telephone | 9039842145 |
| Practice Fax Number | 9039848361 |
| Mailing Address |
4002 Technology Ctr Longview TX 75605-2697 |
| Mailing Telephone | 9032470484 |
| Mailing Fax Number | 9032470485 |
| Certification Date | 2025-03-19 |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2025-09-02 |
| Is Organization Subpart | Y |
| Parent Organization Legal Business Name | PHYNET, INC. |
| Official Name | MR. JOHN D. FORD |
| Official Title | PRESIDENT |
| Telephone | 9032470484 |
| Primary | Code | Classification | Specialization | Taxonomy Group | License Number | License State |
|---|---|---|---|---|---|---|
| Y | 261QH0100X | Clinic/Center | Health Service |
| Other Identifier | Issuing State | Issuer | Identifier Type |
|---|---|---|---|
| 159694201 | TX | MEDICAID |
| Other Organization Name | Type |
|---|---|
| PhyNet, Inc. | Other Name |
| Code | 261QH0100X |
| Taxonomy | Health Service Clinic/Center |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Grouping | Ambulatory Health Care Facilities |
| Definition: Definition to come... |
| Notes: [7/1/2006: modified title] |
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|---|---|---|---|
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| Crucare LLC | 79720 Kidder Rd, Bruce Twp, MI 48065-1336 | Health Service Clinic/Center | 2026-05-27 |
| O2 Life LLC | 1580 Heritage Blvd, West Salem, WI 54669-9418 | Health Service Clinic/Center | 2026-06-02 |
| Professional Services of Holy Cross | 15245 Shady Grove Rd Ste 145, Rockville, MD 20850-6246 | Health Service Clinic/Center | 2026-06-04 |
| Restoreher Health System LLC | 701 Commerce St Ste 603, Dallas, TX 75202-4522 | Health Service Clinic/Center | 2026-05-25 |
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| Shahla Hajialiasgar | 22 Creek Rd Apt 114, Irvine, CA 92604-4758 | Health Service Clinic/Center | 2026-05-26 |
| Occupational Health Centers of Kansas Pa | 10304 Nw Prairie View Rd, Kansas City, MO 64153 | Health Service Clinic/Center | 2026-05-28 |
| Samantha Simon Counseling, PC | 109 Van Buren St, South Haven, MI 49090-1236 | Health Service Clinic/Center | 2026-06-04 |
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| Street Address |
1711 S HENDERSON BLVD STE 300 |
| City | KILGORE |
| State | TX |
| Zip Code | 75662-3563 |
| Country | US |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Megan Leigh Wright | 1711 S Henderson Blvd Ste 300, Kilgore, TX 75662-3563 | Family Nurse Practitioner | 2022-02-18 |
| Linus Scott Medley | 1711 S Henderson Blvd Ste 300, Kilgore, TX 75662-3563 | Family Nurse Practitioner | 2011-01-24 |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Marcy Hall · Marcy Lomelino | 1711 S Henderson Blvd, Kilgore, TX 75662-3563 | Family Nurse Practitioner | 2006-03-22 |
| Michael Mcshan | 1711 S Henderson Blvd, Suite 100, Kilgore, TX 75662-3563 | Emergency Medicine Physician | 2006-10-26 |
| Longhorn Drug Company | 1711 S Henderson Blvd, Kilgore, TX 75662-3563 | Community/Retail Pharmacy | 2005-12-22 |
| Mark L Dillingham | 1711 S Henderson Blvd, Suite 100, Kilgore, TX 75662-3563 | Physician Assistant | 2006-07-07 |
| Longhorn Drug Company | 1711 S Henderson Blvd, #100, Kilgore, TX 75662-3563 | Durable Medical Equipment & Medical Supplies | 2007-02-22 |
| Michael W. Mcshan, M.D., P.A. | 1711 S Henderson Blvd, Suite 300, Kilgore, TX 75662-3563 | Family Medicine Physician | 2012-02-03 |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Linda Louise Hughes | 5264 Fm 2207, Kilgore, TX 75662-0311 | Addiction (Substance Use Disorder) Counselor | 2007-10-26 |
| Lawson Inc. Home Care Services | 1149 Green Blackmon Rd, Kilgore, TX 75662-0805 | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 2010-10-26 |
| Brookshire Grocery Company | 747 Hwy 259 North, Attention Pharmacy Dept, Kilgore, TX 75662 | Pharmacy | 2006-11-16 |
| Heather Rose, Rd LLC | 401e Lantrip St, Kilgore, TX 75662 | Registered Dietitian | 2023-01-05 |
| Jeffery John Pinkerton | 800 Highway 259 North, Kilgore, TX 75662 | Optometrist | 2006-11-06 |
| Wayne E Fertson | 2019 S Henderson Blvd, Ste 1, Kilgore, TX 75662 | Family Medicine Physician | 2006-05-12 |
| Samantha Rae Carlson | 6767 Fm 2204, Kilgore, TX 75662-0702 | Registered Nurse | 2020-02-24 |
| Jennifer Darlene Franks | 6144 Gateway Center Pmb # 320, Kilgore, TX 75662 | Registered Nurse | 2019-07-01 |
| Rachel Thunder Rose Wyatt | 1200 Dudley Road, Kilgore, TX 75662 | Physical Therapist | 2008-02-07 |
| Angie Colbert | 5317 W Goforth Rd, Kilgore, TX 75662-0841 | Transportation Network Company | 2023-02-06 |
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|---|---|---|---|
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| Nakena J Kilgore | 56 Tell St Apt 1f, Providence, RI 02909-1566 | Student in an Organized Health Care Education/Training Program | 2026-04-09 |
| Radiant Life Senior Social Center Inc | 8916 175th St Ste Cf2, Jamaica, NY 11432-5557 | Adult Day Care Clinic/Center | 2026-05-16 |
| New Life Community Center Inc | 7840 Nw 178 St, Palm Springs North, FL 33015 | Case Management Agency | 2019-12-16 |
| Speaking Life 2 You Resource Center, LLC | 8471 Newman St, Douglasville, GA 30134-2420 | Mental Health Counselor | 2026-04-20 |
| Aba Life Center Adult Services LLC | 30a Vreeland Rd Ste 230b, Florham Park, NJ 07932-1924 | Developmentally Disabled Services Day Training Agency | 2026-04-22 |
| Family Life Enrichment Center, Inc. | 3450 New High Shoals Road, High Shoals, GA 30645-0001 | Skilled Nursing Facility | 2007-01-31 |
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This dataset includes over five million health care providers who are assigned National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare & Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under Health Insurance Portability and Accountability Act (HIPAA). Each provider is registered with the NPI, full name, status, address, taxonomy, other identifiers, etc.
| Subject | Transparency and Disclosure |
| Jurisdiction | Federal |
| Data Provider | National Plan and Provider Enumeration System (NPPES), by the Centers for Medicare & Medicaid Services (CMS) |
| Source | download.cms.gov |
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers and all health plans and health care clearinghouses, who must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). All health care providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI. A HIPAA-covered entity is a health care provider that conducts certain transactions in electronic form, or a health care clearinghouse, or a health plan (including commercial plans, Medicare, and Medicaid). Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008. This dataset includes over five million health care providers (individuals and organizations) who are assigned NPI. The provider data elements are disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA), as listed in the NPPES Data Dissemination Notice (CMS-6060-N). The NPI final rules define the following elements which required to be disclosed as determined by Department of Health & Human Services (HHS): NPI, Entity Type, Provider Name, Credential, Business Mailing Address, Business Location Address, Healthcare Provider Taxonomy Code, Other Provider Identifier, Provider Enumeration Date, NPI Deactivation Date, Provider License Number, Authorized Official Name and Contact Information. |