Healthcare Provider Details

I. General information

NPI: 1598153926
Provider Name (Legal Business Name): NORTH TEXAS ER I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 ADAMS DR
WEATHERFORD TX
76086-6266
US

IV. Provider business mailing address

730 ADAMS DR
WEATHERFORD TX
76086-6266
US

V. Phone/Fax

Practice location:
  • Phone: 817-594-0911
  • Fax: 817-594-7724
Mailing address:
  • Phone: 817-594-0911
  • Fax: 817-594-7724

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: CHRISTOPHER KWON
Title or Position: OWNER
Credential: M.D.
Phone: 817-594-0911