1548909906 NPI number — URGENT SPECIALTY ASSOCIATES OF TEXAS, PLLC

Table of content: (NPI 1548909906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548909906 NPI number — URGENT SPECIALTY ASSOCIATES OF TEXAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT SPECIALTY ASSOCIATES OF TEXAS, PLLC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1548909906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13500 POWERS CT STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912-4503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-856-0655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 W MEDICAL CENTER BLVD STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
463-580-8803
Provider Business Practice Location Address Fax Number:
346-358-0888
Provider Enumeration Date:
06/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPHS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-609-9908

Provider Taxonomy Codes

  • Taxonomy code: 2086S0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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