Healthcare Provider Details

I. General information

NPI: 1033594890
Provider Name (Legal Business Name): PROVIDENCE ER OF SPRING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5037-B FM 2920
SPRING TX
77388
US

IV. Provider business mailing address

20320 NORTHWEST FWY STE 900
JERSEY VILLAGE TX
77065-5620
US

V. Phone/Fax

Practice location:
  • Phone: 281-453-2595
  • Fax: 281-440-2020
Mailing address:
  • Phone: 281-586-3888
  • Fax: 281-440-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MINH J NGUYEN
Title or Position: OWNER
Credential:
Phone: 281-453-7916