Healthcare Provider Details

I. General information

NPI: 1023553153
Provider Name (Legal Business Name): BORGATA SCOTSDALE ER MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 N LOOP 250 W
MIDLAND TX
79707-6001
US

IV. Provider business mailing address

3415 N LOOP 250 W
MIDLAND TX
79707-6001
US

V. Phone/Fax

Practice location:
  • Phone: 432-699-0911
  • Fax:
Mailing address:
  • Phone: 432-699-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KYUNGHO SCOTT CHOI
Title or Position: MEMBER
Credential: MD
Phone: 432-699-0911