Provider Demographics
NPI:1538934864
Name:EAST PRESTIGE EMERGENCY ROOM, LLC
Entity type:Organization
Organization Name:EAST PRESTIGE EMERGENCY ROOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-504-4837
Mailing Address - Street 1:11467 HUEBNER RD STE 125
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1028
Mailing Address - Country:US
Mailing Address - Phone:210-504-9122
Mailing Address - Fax:210-783-1795
Practice Address - Street 1:15140 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1212
Practice Address - Country:US
Practice Address - Phone:210-504-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care