Provider Demographics
NPI:1134783913
Name:VILLAGE EMERGENCY ROOM LLC
Entity type:Organization
Organization Name:VILLAGE EMERGENCY ROOM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HORTENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-978-6353
Mailing Address - Street 1:2320 S SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7014
Mailing Address - Country:US
Mailing Address - Phone:713-526-2320
Mailing Address - Fax:713-526-2322
Practice Address - Street 1:17030 NW FWY
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1108
Practice Address - Country:US
Practice Address - Phone:713-526-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134783913OtherVILLAGE EMERGENCY ROOM LLC