MEDICARE: THE EMERGENCY CENTER AT WEST 7TH 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		TX

General Provider Information

NPI Number	:	1538529912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EMERGENCY CENTER AT WEST 7TH LLC

Provider Business Mailing Address
First Line	:	70 S VAL VISTA DR STE A3-620
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-0942
Country	:	US
Telephone Number	:	888-732-3317
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 UNIVERSITY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3012
Country	:	US
Telephone Number	:	888-732-3317
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KEITH BUTLER
Credential	:	M.D.
Telephone Number	:	888-732-3317

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	11/10/2020

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