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General NPI Number Information
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NPI Number | 1598153926
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS ER I LLC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 730 ADAMS DR
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City | WEATHERFORD
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State | TX
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Zip | 76086-6266
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Country | US
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Telephone | 817-594-0911
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Fax | 817-594-7724
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Provider Business Mailing Address
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Address Line | 730 ADAMS DR
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City | WEATHERFORD
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State | TX
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Zip | 76086-6266
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Country | US
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Telephone | 817-594-0911
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Fax | 817-594-7724
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER KWON
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Credential | M.D.
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Telephone | 817-594-0911
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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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