1689002651 NPI number — CR EMERGENCY ROOM, LLC

Table of content: (NPI 1689002651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689002651 NPI number — CR EMERGENCY ROOM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CR 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:
BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL KELLER
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:
1689002651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8686 NEW TRAILS DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77381-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-637-1144
Provider Business Mailing Address Fax Number:
281-292-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76248-4960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-294-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT COORDINATOR
Authorized Official Telephone Number:
713-637-1146

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 303478701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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