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NPI Code Detail

MEDICARE: FIDEM EMERGENCY PARTNERS PLLC

MEDICARE: FIDEM EMERGENCY PARTNERS PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1528465242
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIDEM EMERGENCY PARTNERS PLLC
Provider Business Mailing Address
First Line : 20635 KUYKENDAHL RD
Second Line :
City : SPRING
State : TX
Zip : 77379-3533
Country : US
Telephone Number : 281-363-7170
Fax Number : 281-763-2694
Provider Business Practice Location Address
First Line : 20635 KUYKENDAHL RD
Second Line :
City : SPRING
State : TX
Zip : 77379-3533
Country : US
Telephone Number : 281-363-7170
Fax Number : 281-763-2694
Authorized Official
Title or Position : ADMINISTRATOR
Name : DR. DERRICK ANTHONY MITCHELL
Credential : M.D.
Telephone Number : 936-524-8049
Provider Enumeration Date : 11/24/2014
Last Update Date : 12/21/2014

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Directions to “FIDEM EMERGENCY PARTNERS PLLC ” Practice Location

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