Provider Demographics
NPI:1578872933
Name:EMERGENCY CARE USA
Entity Type:Organization
Organization Name:EMERGENCY CARE USA
Other - Org Name:SOUTHLAKE FREESTANDING EMERGENCY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-442-0577
Mailing Address - Street 1:711 E SOUTHLAKE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6370
Mailing Address - Country:US
Mailing Address - Phone:817-442-0577
Mailing Address - Fax:817-442-0527
Practice Address - Street 1:711 E SOUTHLAKE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6370
Practice Address - Country:US
Practice Address - Phone:817-442-0577
Practice Address - Fax:817-442-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160018261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care