MEDICARE: 2920 ER, 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

General Provider Information

NPI Number	:	1487854568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2920 ER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11012
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77391-1012
Country	:	US
Telephone Number	:	281-257-0404
Fax Number	:	281-257-0447

Provider Business Practice Location Address
First Line	:	6225 FM 2920 RD
Second Line	:	SUITE 150
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	281-257-0404
Fax Number	:	281-257-0447

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SUSHMA GORRELA
Credential	:	M.D
Telephone Number	:	281-257-0404

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	09/12/2018

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