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General NPI Number Information
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NPI Number | 1265666754
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Entity Type | Organization
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Legal Business Name | PINELOCH EMERGENCY CARE
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 1051 PINELOCH DR STE 700
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City | HOUSTON
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State | TX
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Zip | 77062-2742
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Country | US
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Telephone | 281-990-9979
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Fax |
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Provider Business Mailing Address
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Address Line | 1051 PINELOCH DR STE 700
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City | HOUSTON
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State | TX
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Zip | 77062-2742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER WILLETTE
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Credential | M.D.
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Telephone | 713-898-9174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | TX
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