Provider Demographics
NPI:1619549474
Name:ER OF TEXAS COLLEYVILLE
Entity Type:Organization
Organization Name:ER OF TEXAS COLLEYVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BROWNFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-548-0351
Mailing Address - Street 1:5000 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5908
Practice Address - Country:US
Practice Address - Phone:214-548-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care