Basic Information
| Provider Information | |||||||||
| NPI: | 1538661830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DISPATCHHEALTH-TEXAS P A | ||||||||
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| OtherOrganizationName: | DISPATCHHEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3455 RINGSBY CT STE 102 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802164923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035001518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 GRAY FALLS DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770776687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134222920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2018 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | WAGNER | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | ECO | ||||||||
| AuthorizedOfficialTelephone: | 6142264921 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DISPATCHHEALTH-TEXAS P A | ||||||||
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| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.