Provider Demographics
NPI:1891124400
Name:SEMINOLE EXPRESS CARE LLC
Entity Type:Organization
Organization Name:SEMINOLE EXPRESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:TYLER-BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:432-758-6015
Mailing Address - Street 1:201 NE 3RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3613
Mailing Address - Country:US
Mailing Address - Phone:432-758-6015
Mailing Address - Fax:432-758-6016
Practice Address - Street 1:201 NE 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3613
Practice Address - Country:US
Practice Address - Phone:432-758-6015
Practice Address - Fax:432-758-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32050669236261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341511Medicare UPIN