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LUCKYCHARM PRIMARY CARE PLLC
NPI 1336935857
Internal Medicine in Longview, TX

Active since April 21, 2025CLIA 45D2349542 · Waiver
3521 N FOURTH STREET, SUITE 100, LONGVIEW, TX 75605(903) 448-2273(773) 825-8352 Get Directions Write a Review

NPPES record last updated: December 29, 2025. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Dec 29, 2025, Nov 5, 2025 (2 updates tracked since 2025).

About Luckycharm Primary Care Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LUCKYCHARM PRIMARY CARE PLLC (NPI 1336935857) is a healthcare organization registered as an internal medicine in Longview, Texas and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through August 23, 2028, maintains a secondary practice location in Longview, and lists Uchenne Evans Mbaraonye, Owner, as its authorized official.

NPPES Registry Identity

NPI1336935857
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameLUCKYCHARM PRIMARY CARE PLLC
Location Address3521 N FOURTH STREET, SUITE 100Longview, TX 75605
Mailing Address2309 Gilmer Rd Ste 101Longview, TX 75604-2133 · (903) 488-2273 · Fax (773) 825-8352
Phone(903) 448-2273
Fax(773) 825-8352
Organization SubpartNo
Authorized OfficialUchenne Evans MbaraonyeOwner · (937) 554-8570
Enumeration DateApril 21, 2025
Last NPPES UpdateDecember 29, 20252 updates tracked since enumeration
NPPES CertifiedDecember 29, 2025
✔ NPI 1336935857 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3521 N FOURTH STREET, SUITE 100, Longview, TX 75605
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Secondary Practice Location 1

Location 11000 N High St Ste 21Longview, TX 75601-5105 · Phone (903) 488-2273 · Fax (773) 825-8352

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2349542

Luckycharm Primary Care · Longview, TX
Active · expires Aug 23, 2028
CLIA Number45D2349542
Laboratory TypePhysician Office
Certificate Effective DateAugust 24, 2026
Certificate Expiration DateAugust 23, 2028
Laboratory DirectorUchenne E. Mbaraonye
Laboratory Phone(903) 488-2273
Laboratory LocationLuckycharm Primary Care3521 N 4th St Ste 100, Longview, TX 75605
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Luckycharm Primary Care PLLC's NPI number?

The NPI number for Luckycharm Primary Care PLLC is 1336935857. It was assigned to this organization in the NPPES registry on April 21, 2025.

Where is Luckycharm Primary Care PLLC located?

Luckycharm Primary Care PLLC is located at 3521 N Fourth Street, Suite 100, Longview, TX 75605. The listed phone number is (903) 448-2273.

What is Luckycharm Primary Care PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Luckycharm Primary Care PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2349542) is associated with this NPI, valid through August 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Luckycharm Primary Care PLLC was last updated on December 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.