Basic Information
| Provider Information | |||||||||
| NPI: | 1861908196 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NUCH OF TEXAS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDPOST - CONVERSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 EASTPARK DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370272311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156004074 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8380 FM 78 | ||||||||
| Address2: | |||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781091057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106100475 | ||||||||
| FaxNumber: | 2106108671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2017 | ||||||||
| LastUpdateDate: | 02/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | ENDERLE | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED SIGNATORY | ||||||||
| AuthorizedOfficialTelephone: | 6156004120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.