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General NPI Number Information
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NPI Number | 1801681606
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Entity Type | Organization
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Legal Business Name | FOSSIL CREEK ERS ACQUISITION PARTNERS LLC
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 22250 BULVERDE RD STE 120
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City | SAN ANTONIO
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State | TX
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Zip | 78261-3082
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Country | US
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Telephone | 210-401-8185
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93059
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1059
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Country | US
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Telephone | 817-420-0034
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JULIE RADLEY
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Credential |
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Telephone | 713-591-2256
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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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