MEDICARE: NEC GRAND PRAIRIE EMERGENCY CENTER, LP

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	:	1528501103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEC GRAND PRAIRIE EMERGENCY CENTER, LP

Provider Business Mailing Address
First Line	:	PO BOX 4980
Second Line	:	MSC 775
City	:	HOUSTON
State	:	TX
Zip	:	77210-4980
Country	:	US
Telephone Number	:	713-781-4500
Fax Number	:	713-781-4800

Provider Business Practice Location Address
First Line	:	725 W PIONEER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-4849
Country	:	US
Telephone Number	:	713-781-4500
Fax Number	:	713-781-4800

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	BRANDY PERRY
Credential	:
Telephone Number	:	713-781-4500

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	11/30/2016

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