Provider Demographics
NPI:1942519335
Name:SOUTHLAKE DOCTORS EXPRESS, PA PSC
Entity Type:Organization
Organization Name:SOUTHLAKE DOCTORS EXPRESS, PA PSC
Other - Org Name:AFC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:817-488-9922
Mailing Address - Street 1:2315 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE110
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6691
Mailing Address - Country:US
Mailing Address - Phone:817-488-9922
Mailing Address - Fax:817-488-8917
Practice Address - Street 1:2315 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6691
Practice Address - Country:US
Practice Address - Phone:817-488-9922
Practice Address - Fax:817-488-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care