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General NPI Number Information
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NPI Number | 1891124400
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Entity Type | Organization
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Legal Business Name | SEMINOLE EXPRESS CARE LLC
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 201 NE 3RD ST SUITE C
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City | SEMINOLE
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State | TX
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Zip | 79360-3613
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Country | US
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Telephone | 432-758-6015
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Fax | 432-758-6016
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Provider Business Mailing Address
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Address Line | 201 NE 3RD ST SUITE C
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City | SEMINOLE
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State | TX
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Zip | 79360-3613
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Country | US
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Telephone | 432-758-6015
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Fax | 432-758-6016
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ERICKA LANE TYLER-BENSON
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Credential | RN, BSN, MBA
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Telephone | 432-758-6015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 32050669236
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License Number State | TX
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