Provider Demographics
NPI:1508593914
Name:ER OF KELLER PLLC
Entity Type:Organization
Organization Name:ER OF KELLER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:4561 HERITAGE TRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8906
Mailing Address - Country:US
Mailing Address - Phone:214-906-8899
Mailing Address - Fax:
Practice Address - Street 1:4561 HERITAGE TRACE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8906
Practice Address - Country:US
Practice Address - Phone:214-906-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty