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General NPI Number Information
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NPI Number | 1811227150
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Entity Type | Organization
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Legal Business Name | EMERGENCY MEDICAL DOCTORS SERVICES PLLC
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 1201 S ALLEN GENOA RD
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City | HOUSTON
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State | TX
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Zip | 77587-4464
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Country | US
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Telephone | 713-910-0000
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Fax | 713-910-0004
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Provider Business Mailing Address
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Address Line | 1201 S ALLEN GENOA RD
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City | HOUSTON
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State | TX
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Zip | 77587-4464
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Country | US
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Telephone | 713-910-0000
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Fax | 713-910-0004
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Authorized Official
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Title or Position | OWNER
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Name | DR. AGBOLADE O ODUTAYO
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Credential | D.O
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Telephone | 713-910-0000
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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 | K6196
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | K6196
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | K6196
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License Number State | TX
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