Healthcare Provider Details

I. General information

NPI: 1528006459
Provider Name (Legal Business Name): LULING EMERGENCY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HAYS ST
LULING TX
78648-3207
US

IV. Provider business mailing address

6300 LA CALMA DR SUITE 200
AUSTIN TX
78752-3843
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-7000
  • Fax:
Mailing address:
  • Phone: 512-452-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAM ROBERTS
Title or Position: PRESIDENT
Credential: MD
Phone: 512-452-8533