Provider Demographics
NPI:1417340142
Name:CODE 3 EMERGENCY PARTNERS AT CRAIG RANCH, LLC
Entity Type:Organization
Organization Name:CODE 3 EMERGENCY PARTNERS AT CRAIG RANCH, LLC
Other - Org Name:CODE 3 ER AT FRISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-320-9820
Mailing Address - Street 1:5300 TOWN AND COUNTRY BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6913
Mailing Address - Country:US
Mailing Address - Phone:469-320-9820
Mailing Address - Fax:214-260-0707
Practice Address - Street 1:12600 ROLATER RD STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5188
Practice Address - Country:US
Practice Address - Phone:972-549-2040
Practice Address - Fax:972-549-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care