Provider Demographics
NPI:1679976120
Name:BAYMONT EMERGENCY ROOM, LLC
Entity Type:Organization
Organization Name:BAYMONT EMERGENCY ROOM, LLC
Other - Org Name:PATIENTS EMERGENCY ROOM AND HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-576-0555
Mailing Address - Street 1:10133 INTERSTATE 10 E
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-7641
Mailing Address - Country:US
Mailing Address - Phone:281-576-0555
Mailing Address - Fax:281-209-8930
Practice Address - Street 1:10133 INTERSTATE 10 E
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-7641
Practice Address - Country:US
Practice Address - Phone:281-576-0555
Practice Address - Fax:281-209-8930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATIENTS EMERGENCY ROOM AND HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-29
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH143EOtherBLUE CROSS BLUE SHIELD OF TEXAS