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General NPI Number Information
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NPI Number | 1831513944
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Entity Type | Organization
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Legal Business Name | FOSSIL CREEK ER PHYSICIANS PLLC
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 22250 BULVERDE RD SUITE 120
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City | SAN ANTONIO
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State | TX
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Zip | 78261-3084
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Country | US
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Telephone | 210-401-8185
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Fax | 210-401-8187
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Provider Business Mailing Address
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Address Line | PO BOX 93058
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1058
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Country | US
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Telephone | 817-421-0034
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Fax | 817-421-0036
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | MR. JOHN NEIMAN
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Credential | ESQ.
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Telephone | 817-421-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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