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General NPI Number Information
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NPI Number | 1851028146
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Entity Type | Organization
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Legal Business Name | EMERGENCY ROOM OF KELLER LLC
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 4561 HERITAGE TRACE PKWY
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City | FORT WORTH
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State | TX
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Zip | 76244-8906
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Country | US
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Telephone | 817-945-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 4561 HERITAGE TRACE PKWY
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City | FORT WORTH
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State | TX
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Zip | 76244-8906
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Country | US
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Telephone | 214-906-8899
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ABBAS MIAN
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Credential | MD
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Telephone | 817-945-4200
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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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