MEDICARE: ERCA LITTLE ELM 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	261QE0002X	Emergency Care Clinic/Center
2	261QE0002X	Emergency Care Clinic/Center	160056	TX

General Provider Information

NPI Number	:	1750644746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERCA LITTLE ELM LLC

Provider Business Mailing Address
First Line	:	6501 PRESTON RD
Second Line	:	STE 102
City	:	PLANO
State	:	TX
Zip	:	75024-2610
Country	:	US
Telephone Number	:	972-403-1155
Fax Number	:	972-608-0844

Provider Business Practice Location Address
First Line	:	2700 E ELDORADO PKWY
Second Line	:	STE 104
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-0000
Country	:	US
Telephone Number	:	972-987-4395
Fax Number	:	972-987-4768

Authorized Official
Title or Position	:	MANAGER/COO
Name	:	MR. JOHN A MCGEE
Credential	:
Telephone Number	:	214-619-2060

Provider Enumeration Date	:	06/24/2012
Last Update Date	:	12/30/2014

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