Provider Demographics
NPI:1740603422
Name:22250 BULVERDE CEC FOSSIL CREEK LLC
Entity Type:Organization
Organization Name:22250 BULVERDE CEC FOSSIL CREEK LLC
Other - Org Name:FOSSIL CREEK COMPLETE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-591-2256
Mailing Address - Street 1:PO BOX 93059
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1059
Mailing Address - Country:US
Mailing Address - Phone:817-421-0034
Mailing Address - Fax:817-421-0036
Practice Address - Street 1:22250 BULVERDE RD
Practice Address - Street 2:120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-3084
Practice Address - Country:US
Practice Address - Phone:817-421-0034
Practice Address - Fax:817-421-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care