Provider Demographics
NPI:1326580960
Name:LAKEWOOD EMERGENCY ROOM
Entity type:Organization
Organization Name:LAKEWOOD EMERGENCY ROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-436-8100
Mailing Address - Street 1:101 W RENNER RD STE 140
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2028
Mailing Address - Country:US
Mailing Address - Phone:469-436-8100
Mailing Address - Fax:
Practice Address - Street 1:6101 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2602
Practice Address - Country:US
Practice Address - Phone:469-372-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care