Healthcare Provider Details

I. General information

NPI: 1912586637
Provider Name (Legal Business Name): SPTX EMERGENCY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 FM 2920 RD
SPRING TX
77388-3417
US

IV. Provider business mailing address

5525 BURNET RD STE A
AUSTIN TX
78756-1646
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-0911
  • Fax:
Mailing address:
  • Phone: 512-371-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEREMY KENTER
Title or Position: CMO
Credential: DO
Phone: 512-451-0911