Provider Demographics
NPI:1083147490
Name:PORTER EMERGENCY ROOM LLC
Entity Type:Organization
Organization Name:PORTER EMERGENCY ROOM LLC
Other - Org Name:PORTER EMERGENCY ROOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOPARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-326-8032
Mailing Address - Street 1:24540 FM 1314 RD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4204
Mailing Address - Country:US
Mailing Address - Phone:281-354-4009
Mailing Address - Fax:
Practice Address - Street 1:24540 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4204
Practice Address - Country:US
Practice Address - Phone:281-354-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care