Provider Demographics
NPI:1073058939
Name:COLLEGE STATION ER, LLC
Entity Type:Organization
Organization Name:COLLEGE STATION ER, LLC
Other - Org Name:SIGNATURE CARE EMERGENCY CENTER - COLLEGE STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-699-3777
Mailing Address - Street 1:PO BOX 733363
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3363
Mailing Address - Country:US
Mailing Address - Phone:979-213-5520
Mailing Address - Fax:281-752-7961
Practice Address - Street 1:1512 TEXAS AVE S
Practice Address - Street 2:SUITE 500
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3329
Practice Address - Country:US
Practice Address - Phone:979-213-5520
Practice Address - Fax:281-752-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160304207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty