Provider Demographics
NPI:1396097945
Name:E-DOC URGENT CARE CLINIC, LLC
Entity type:Organization
Organization Name:E-DOC URGENT CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:GURRAM
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-808-3443
Mailing Address - Street 1:2810 BROOKSHIRE DR
Mailing Address - Street 2:SOUTHLAKE
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8933
Mailing Address - Country:US
Mailing Address - Phone:817-332-6644
Mailing Address - Fax:817-887-5522
Practice Address - Street 1:651 N DENTON TAP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2007
Practice Address - Country:US
Practice Address - Phone:817-332-6644
Practice Address - Fax:817-887-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherMEDICAL URGENT CARE SERVICES