Healthcare Provider Details

I. General information

NPI: 1942928064
Provider Name (Legal Business Name): SRM URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 HIGHWAY 36 S STE 600
ROSENBERG TX
77471-9119
US

IV. Provider business mailing address

3514 HIGHWAY 36 S STE 600
ROSENBERG TX
77471-9119
US

V. Phone/Fax

Practice location:
  • Phone: 716-601-4010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIGISHA TANMAY SHAH
Title or Position: MEDICAL DIRECTOR/MANAGER
Credential: MD
Phone: 716-601-4010