1134783913 NPI number — VILLAGE EMERGENCY ROOM LLC

Table of content: (NPI 1134783913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134783913 NPI number — VILLAGE EMERGENCY ROOM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE EMERGENCY ROOM LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VILLAGE EMERGENCY ROOM LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134783913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 S SHEPHERD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77019-7014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-526-2320
Provider Business Mailing Address Fax Number:
713-526-2322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17030 NW FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY VILLAGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77040-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-526-2320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LUNA
Authorized Official First Name:
HORTENCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
832-978-6353

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1134783913 . This is a "VILLAGE EMERGENCY ROOM LLC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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