Provider Demographics
NPI:1396260543
Name:ERLC PHYSICIAN STAFFING COMPANY LLC
Entity type:Organization
Organization Name:ERLC PHYSICIAN STAFFING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ANTILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-252-1551
Mailing Address - Street 1:203 HOLLY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4630
Mailing Address - Country:US
Mailing Address - Phone:713-252-1551
Mailing Address - Fax:281-836-6106
Practice Address - Street 1:2530 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6743
Practice Address - Country:US
Practice Address - Phone:281-337-7500
Practice Address - Fax:281-836-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty