Provider Demographics
NPI:1801364450
Name:EMCC AZLE, LLC
Entity Type:Organization
Organization Name:EMCC AZLE, LLC
Other - Org Name:ENCORE MEDICAL CENTERS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-830-8200
Mailing Address - Street 1:2300 MATLOCK RD STE 35
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5018
Mailing Address - Country:US
Mailing Address - Phone:469-830-8200
Mailing Address - Fax:469-830-8201
Practice Address - Street 1:611 NORTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2915
Practice Address - Country:US
Practice Address - Phone:817-270-0777
Practice Address - Fax:817-270-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty