Provider Demographics
NPI:1407392566
Name:SAN ANGELO ER LLC
Entity Type:Organization
Organization Name:SAN ANGELO ER LLC
Other - Org Name:CONCHO VALLEY ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SPECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-392-3511
Mailing Address - Street 1:5709 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5643
Mailing Address - Country:US
Mailing Address - Phone:325-703-6900
Mailing Address - Fax:325-703-6910
Practice Address - Street 1:5709 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:713-660-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care