Provider Demographics
NPI:1588943823
Name:EDOC URGENT CARE CENTER
Entity type:Organization
Organization Name:EDOC URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-899-3722
Mailing Address - Street 1:651 N DENTON TAP RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2010
Mailing Address - Country:US
Mailing Address - Phone:972-899-3722
Mailing Address - Fax:
Practice Address - Street 1:651 N DENTON TAP RD STE 100
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2010
Practice Address - Country:US
Practice Address - Phone:972-899-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care