Provider Demographics
NPI:1811227150
Name:EMERGENCY MEDICAL DOCTORS SERVICES PLLC
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL DOCTORS SERVICES PLLC
Other - Org Name:EMERGENCY MEDICAL DOCTORS SERVICES URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGBOLADE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUTAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-910-0000
Mailing Address - Street 1:1201 S ALLEN GENOA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-4464
Mailing Address - Country:US
Mailing Address - Phone:713-910-0000
Mailing Address - Fax:713-910-0004
Practice Address - Street 1:1201 S ALLEN GENOA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-4464
Practice Address - Country:US
Practice Address - Phone:713-910-0000
Practice Address - Fax:713-910-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6196207P00000X, 261QE0002X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty