Provider Demographics
NPI:1467025676
Name:ER OF WATAUGA PLLC
Entity Type:Organization
Organization Name:ER OF WATAUGA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-906-8899
Mailing Address - Street 1:5401 BASSWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6909
Mailing Address - Country:US
Mailing Address - Phone:179-455-5008
Mailing Address - Fax:817-945-5600
Practice Address - Street 1:5401 BASSWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-6909
Practice Address - Country:US
Practice Address - Phone:179-455-5008
Practice Address - Fax:817-945-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care