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NPI Code Detail

MEDICARE: SE TEXAS EP, PLLC

MEDICARE: SE TEXAS EP, 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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number : 1609431568
Entity Type Code : Organization
Provider Name (Legal Business Name) : SE TEXAS EP, PLLC
Provider Business Mailing Address
First Line : 6030 S RICE AVE STE C
Second Line :
City : HOUSTON
State : TX
Zip : 77081-2944
Country : US
Telephone Number : 713-660-0557
Fax Number :
Provider Business Practice Location Address
First Line : 19211 MCKAY DR
Second Line :
City : HUMBLE
State : TX
Zip : 77338-5502
Country : US
Telephone Number : 713-660-0555
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : TOM VO
Credential : MD
Telephone Number : 713-660-0557
Provider Enumeration Date : 05/07/2019
Last Update Date : 08/20/2019

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