Provider Demographics
NPI:1043545940
Name:BUNKER HILL URGENT CARE PLLC DBA ENTRUST IMMEDIATE CARE
Entity Type:Organization
Organization Name:BUNKER HILL URGENT CARE PLLC DBA ENTRUST IMMEDIATE CARE
Other - Org Name:BUNKER HILL URGENT CARE PLLC DBA ENTRUST IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-734-0335
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:DEPT #132
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1476
Mailing Address - Country:US
Mailing Address - Phone:616-734-0334
Mailing Address - Fax:616-949-8540
Practice Address - Street 1:9778 KATY FREEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-468-7845
Practice Address - Fax:713-468-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7240261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care