MEDICARE: LIFE SAVERS EMERGENCY ROOM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center	160205	TX

General Provider Information

NPI Number	:	1003280629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SAVERS EMERGENCY ROOM LLC

Provider Business Mailing Address
First Line	:	17685 TOMBALL PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1011
Country	:	US
Telephone Number	:	832-779-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	17685 TOMBALL PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1011
Country	:	US
Telephone Number	:	832-779-5433
Fax Number	:	832-604-6291

Authorized Official
Title or Position	:	CEO
Name	:	DR. FOYEKE IKYAATOR
Credential	:	M.D.
Telephone Number	:	832-779-5433

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	12/13/2024

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