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General NPI Number Information
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NPI Number | 1255978722
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Entity Type | Organization
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Legal Business Name | MEDCO ER CARROLLTON, LLC
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 2745 E BELT LINE RD
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City | CARROLLTON
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State | TX
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Zip | 75006-5436
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Country | US
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Telephone | 469-478-4200
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Fax | 469-840-4608
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Provider Business Mailing Address
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Address Line | PO BOX 64547
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City | LUBBOCK
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State | TX
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Zip | 79464-4547
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Country | US
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Telephone | 469-478-4200
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Fax | 469-840-4608
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | DORMA L KOHLER
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Credential | MBA
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Telephone | 832-248-6900
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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 |
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License Number State |
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