Provider Demographics
NPI:1396429700
Name:ATASCOCITA FIRST ER LLC
Entity type:Organization
Organization Name:ATASCOCITA FIRST ER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-877-8723
Mailing Address - Street 1:1233 YALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19143 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-4800
Practice Address - Country:US
Practice Address - Phone:713-955-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty