Provider Demographics
NPI:1023553153
Name:BORGATA SCOTSDALE ER MANAGEMENT LLC
Entity Type:Organization
Organization Name:BORGATA SCOTSDALE ER MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KYUNGHO
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-699-0911
Mailing Address - Street 1:3415 N LOOP 250 W
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-6001
Mailing Address - Country:US
Mailing Address - Phone:432-699-0911
Mailing Address - Fax:
Practice Address - Street 1:3415 N LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6001
Practice Address - Country:US
Practice Address - Phone:432-699-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care