Provider Demographics
NPI:1427618370
Name:EMCC CORPUS MIDTOWN ER LLC
Entity type:Organization
Organization Name:EMCC CORPUS MIDTOWN ER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-830-8200
Mailing Address - Street 1:2300 MATLOCK RD STE 35
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5018
Mailing Address - Country:US
Mailing Address - Phone:469-830-8200
Mailing Address - Fax:469-830-8201
Practice Address - Street 1:4117 S STAPLES ST STE 140
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5506
Practice Address - Country:US
Practice Address - Phone:361-855-1121
Practice Address - Fax:361-500-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty