Provider Demographics
NPI:1598153926
Name:NORTH TEXAS ER I LLC
Entity Type:Organization
Organization Name:NORTH TEXAS ER I LLC
Other - Org Name:EXCEL ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-594-0911
Mailing Address - Street 1:730 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6266
Mailing Address - Country:US
Mailing Address - Phone:817-594-0911
Mailing Address - Fax:817-594-7724
Practice Address - Street 1:730 ADAMS DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6266
Practice Address - Country:US
Practice Address - Phone:817-594-0911
Practice Address - Fax:817-594-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160167OtherTDSHS FSEC LICENSE