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General NPI Number Information
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NPI Number | 1538465679
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Entity Type | Organization
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Legal Business Name | AMERICAN EAGLE PHYSICIAN HOUSE CALL INC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 6515 BRIAR LAKE TRL
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City | SACHSE
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State | TX
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Zip | 75048-5526
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Country | US
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Telephone | 496-544-3556
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Fax | 972-442-3391
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Provider Business Mailing Address
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Address Line | 6515 BRIAR LAKE TRL
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City | SACHSE
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State | TX
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Zip | 75048-5526
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Country | US
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Telephone | 469-544-3556
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Fax | 972-442-3391
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Authorized Official
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Title or Position | OWNER/ADMIN
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Name | EBERECHI ANN SOLOMON
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Credential | NP
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Telephone | 469-544-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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