Healthcare Provider Details

I. General information

NPI: 1366828964
Provider Name (Legal Business Name): NORTH TEXAS ER II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 HERITAGE TRACE PARKWAY
KELLER TX
76244
US

IV. Provider business mailing address

4561 HERITAGE TRACE PARKWAY
KELLER TX
76244
US

V. Phone/Fax

Practice location:
  • Phone: 817-753-7911
  • Fax:
Mailing address:
  • Phone: 817-753-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS MCLAIN
Title or Position: MANAGER
Credential: M.D.
Phone: 817-594-0911