Healthcare Provider Details

I. General information

NPI: 1376018382
Provider Name (Legal Business Name): TEXARKANA EMERGENCY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MALL DR
TEXARKANA TX
75503-2560
US

IV. Provider business mailing address

2001 MALL DR
TEXARKANA TX
75503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 903-306-2126
  • Fax:
Mailing address:
  • Phone: 903-306-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DARLEEN CALLAHAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 832-699-3777