Healthcare Provider Details

I. General information

NPI: 1144566316
Provider Name (Legal Business Name): ESWCT CEDAR PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EAST WHITESTONE BLVD.
CEDAR PARK TX
78613
US

IV. Provider business mailing address

8686 NEW TRAILS DR SUITE 100
THE WOODLANDS TX
77381-1176
US

V. Phone/Fax

Practice location:
  • Phone: 713-637-1044
  • Fax:
Mailing address:
  • Phone: 713-637-1044
  • Fax: 281-292-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOHN BUCK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 713-637-1044