Provider Demographics
NPI:1598497638
Name:SILVERLAKE ER LLC
Entity Type:Organization
Organization Name:SILVERLAKE ER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOATH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-766-1096
Mailing Address - Street 1:2752 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4400
Mailing Address - Country:US
Mailing Address - Phone:713-766-1096
Mailing Address - Fax:832-464-4760
Practice Address - Street 1:2752 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4400
Practice Address - Country:US
Practice Address - Phone:713-766-1096
Practice Address - Fax:832-464-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760822886Medicaid
TX1558620542Medicaid