Provider Demographics
NPI:1407344880
Name:CR EMERGENCY ROOM LLC
Entity Type:Organization
Organization Name:CR EMERGENCY ROOM LLC
Other - Org Name:BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL ROCKWALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-441-0674
Mailing Address - Street 1:8686 NEW TRAILS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1176
Mailing Address - Country:US
Mailing Address - Phone:713-637-1146
Mailing Address - Fax:281-298-5311
Practice Address - Street 1:1975 ALPHA DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4951
Practice Address - Country:US
Practice Address - Phone:214-294-6200
Practice Address - Fax:713-637-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303478701Medicaid
TX67-0062OtherMEDICARE