Healthcare Provider Details

I. General information

NPI: 1164910360
Provider Name (Legal Business Name): USA EMERGENCY CENTERS-RIVERSTONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4734 L J PKWY UNIT 310
SUGAR LAND TX
77479
US

IV. Provider business mailing address

PO BOX 61160
CORPUS CHRISTI TX
78466-1160
US

V. Phone/Fax

Practice location:
  • Phone: 361-884-2904
  • Fax: 361-884-2919
Mailing address:
  • Phone: 361-884-2904
  • Fax: 361-884-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED T SHAHAN
Title or Position: PARTNER
Credential: MD
Phone: 509-389-3318