Provider Demographics
NPI: | 1205225299 |
---|---|
Name: | SAN JACINTO EMERGENCY PHYSICIANS PLLC |
Entity Type: | Organization |
Organization Name: | SAN JACINTO EMERGENCY PHYSICIANS PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GRIMES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-551-6611 |
Mailing Address - Street 1: | PO BOX 8148 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76124-0148 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-451-4208 |
Mailing Address - Fax: | 817-563-3699 |
Practice Address - Street 1: | 4401 GARTH RD |
Practice Address - Street 2: | |
Practice Address - City: | BAYTOWN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77521-2122 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-420-8600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-01-14 |
Last Update Date: | 2023-01-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | J8535 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty |