Basic Information
| Provider Information | |||||||||
| NPI: | 1760075865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY CARE OF MESQUITE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 S FREMONT RIDGE LOOP | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773895126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696491007 | ||||||||
| FaxNumber: | 8323081272 | ||||||||
| Practice Location | |||||||||
| Address1: | 1080 E CARTWRIGHT RD | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751496622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696491007 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2021 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | NALLURI | ||||||||
| AuthorizedOfficialFirstName: | PRASADA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4696491007 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.