Provider Demographics
NPI:1447780655
Name:RELIANT ER PHYSICIAN SERVICES, PA
Entity Type:Organization
Organization Name:RELIANT ER PHYSICIAN SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DURO
Authorized Official - Last Name:OLOYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-885-0075
Mailing Address - Street 1:1025 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2041
Mailing Address - Country:US
Mailing Address - Phone:361-885-0075
Mailing Address - Fax:361-885-0308
Practice Address - Street 1:6813 EVERHART ROAD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2453
Practice Address - Country:US
Practice Address - Phone:361-855-8700
Practice Address - Fax:361-855-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care