MEDICARE: MONROE EMERGENCY CARE LLC

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
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1548544018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE EMERGENCY CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 87667
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77287-7667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8535 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5055
Country	:	US
Telephone Number	:	832-687-9936
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ MANAGER
Name	:	MR. LLOYD DAVID RANDALL
Credential	:
Telephone Number	:	832-687-9936

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	10/12/2011

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Directions to “MONROE EMERGENCY CARE LLC ” Practice Location

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