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General NPI Number Information
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NPI Number | 1184048068
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Entity Type | Organization
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Legal Business Name | EC MANSFIELD, LLC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 1710 HIGHWAY 287 N
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City | MANSFIELD
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State | TX
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Zip | 76063-7534
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Country | US
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Telephone | 817-225-4570
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Fax | 281-209-8930
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Provider Business Mailing Address
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Address Line | 211 HIGHLAND CROSS DR SUITE 275
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City | HOUSTON
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State | TX
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Zip | 77073-1733
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Country | US
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Telephone | 281-784-1500
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Fax | 281-209-8930
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIMOTHY SEAY
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Credential | M.D.
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Telephone | 281-784-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 160102
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License Number State | TX
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