=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639946700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILSBEE URGENT CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2023
-----------------------------------------------------
Last Update Date | 12/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 HIGHWAY 96 S
-----------------------------------------------------
City | SILSBEE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77656-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-333-1272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6925 NOTTOWAY LN
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77657-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-550-6088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TRAVIS READ
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 409-550-6088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------