Basic Information
| Provider Information | |||||||||
| NPI: | 1699364737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSTON STAT ER GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6075 POPLAR AVE STE 401 | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017953600 | ||||||||
| FaxNumber: | 9017956060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 TWELVE OAKS PLACE | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770276899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139807900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2021 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHOPRA | ||||||||
| AuthorizedOfficialFirstName: | LUCKY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7139807900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.