MEDICARE: CALDER IMMEDIATE CARE PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1104193564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALDER IMMEDIATE CARE PLLC

Provider Business Mailing Address
First Line	:	1108 GULF FWY S
Second Line	:	STE 220
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5100
Country	:	US
Telephone Number	:	281-557-4404
Fax Number	:	281-557-4443

Provider Business Practice Location Address
First Line	:	1108 GULF FWY S
Second Line	:	STE 220
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5100
Country	:	US
Telephone Number	:	281-557-4404
Fax Number	:	281-557-4443

Authorized Official
Title or Position	:	VP
Name	:	TODD EVANS
Credential	:
Telephone Number	:	713-852-1550

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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