Basic Information
| Provider Information | |||||||||
| NPI: | 1174937668 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMPLETE EMERGENCY CARE SOUTHLAKE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPLETE CARE SOUTHLAKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 93806 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760920117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174210034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 321 W SOUTHLAKE BLVD STE 140 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760926186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174210034 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | NEIMAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 8174210034 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.