=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164030466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST ANTHONYS EMERGENCY ROOM KATY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2020
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25910 WESTHEIMER PKWY STE 100
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-5391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-257-4709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25910 WESTHEIMER PKWY STE 100
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-5391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-257-4709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | ANGELA MACKEY MITCHELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 346-257-4709
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------