Provider Demographics
NPI:1710391255
Name:PREMIER ONE EMERGENCY CENTERS AT FRISCO STARWOOD, LLC
Entity Type:Organization
Organization Name:PREMIER ONE EMERGENCY CENTERS AT FRISCO STARWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-447-0381
Mailing Address - Street 1:1415 LEGACY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6027
Mailing Address - Country:US
Mailing Address - Phone:214-447-0381
Mailing Address - Fax:
Practice Address - Street 1:5649 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7263
Practice Address - Country:US
Practice Address - Phone:972-310-4153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER ONE EMERGENCY CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-12
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care