Provider Demographics
NPI:1467067686
Name:15140 NARSAN ER PHYSICIAN PLLC
Entity Type:Organization
Organization Name:15140 NARSAN ER PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-421-0034
Mailing Address - Street 1:910 S KIMBALL AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9005
Mailing Address - Country:US
Mailing Address - Phone:817-527-3403
Mailing Address - Fax:
Practice Address - Street 1:15140 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1212
Practice Address - Country:US
Practice Address - Phone:210-469-4409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty