Provider Demographics
NPI:1538680467
Name:EPSS LLC - CENTRAL SERIES
Entity Type:Organization
Organization Name:EPSS LLC - CENTRAL SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-451-4208
Mailing Address - Street 1:6300 RIDGLEA PL STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5707
Mailing Address - Country:US
Mailing Address - Phone:1817-451-4208
Mailing Address - Fax:817-563-3699
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:817-451-4208
Practice Address - Fax:817-563-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098328207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty