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General NPI Number Information
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NPI Number | 1306100995
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Entity Type | Organization
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Legal Business Name | ERCA COPPELL LLC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 750 S MACARTHUR BLVD
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City | COPPELL
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State | TX
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Zip | 75019-4200
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Country | US
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Telephone | 940-733-5206
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 WALTHAM DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9605
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Country | US
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Telephone | 940-733-5206
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRAXTON NEIMAN
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Credential |
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Telephone | 940-733-5206
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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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