MEDICARE: ESS OF CONROE 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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1558956672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESS OF CONROE LLC

Provider Business Mailing Address
First Line	:	17304 PRESTON RD STE 1400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5633
Country	:	US
Telephone Number	:	866-931-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 S LOOP 336 W STE 500
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3315
Country	:	US
Telephone Number	:	936-647-3500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RON WEISS
Credential	:
Telephone Number	:	866-931-8882

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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Directions to “ESS OF CONROE LLC ” Practice Location

Language	Start Address	Practice Location

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