Healthcare Provider Details

I. General information

NPI: 1932094976
Provider Name (Legal Business Name): CITY BASE ERS ACQUISITION PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 SE MILITARY DR # 101
SAN ANTONIO TX
78223-4312
US

IV. Provider business mailing address

PO BOX 93703
SOUTHLAKE TX
76092-0116
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-1777
  • Fax:
Mailing address:
  • Phone: 210-704-1777
  • 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: JULIE RADLEY
Title or Position: COO
Credential:
Phone: 713-591-2256