Basic Information
| Provider Information | |||||||||
| NPI: | 1659744662 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ER24 DENTON, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUREPOINT EMERGENCY CENTER DENTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 RIDGEVIEW DR STE 140-111 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750135543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143907697 | ||||||||
| FaxNumber: | 9724326692 | ||||||||
| Practice Location | |||||||||
| Address1: | 2426 LILLIAN MILLER PKWY | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762052908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729542133 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | NEWSOM | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4698308200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ENCORE MEDICAL CENTERS | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 13764 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.