Provider Demographics
NPI:1104203363
Name:CONVERSE MEDICAL CENTER
Entity Type:Organization
Organization Name:CONVERSE MEDICAL CENTER
Other - Org Name:FIRST CHOICE EMERGENCY ROOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-6650
Mailing Address - Street 1:PO BOX 840795
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0795
Mailing Address - Country:US
Mailing Address - Phone:972-899-6650
Mailing Address - Fax:972-899-5954
Practice Address - Street 1:7898 KITTY HAWK RD
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-0000
Practice Address - Country:US
Practice Address - Phone:210-462-1210
Practice Address - Fax:210-462-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160164261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX434148OtherJCAHO