Provider Demographics
NPI:1699239780
Name:ER ADDISON LLC
Entity type:Organization
Organization Name:ER ADDISON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-894-9436
Mailing Address - Street 1:15240 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4610
Mailing Address - Country:US
Mailing Address - Phone:817-894-9436
Mailing Address - Fax:
Practice Address - Street 1:15240 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4610
Practice Address - Country:US
Practice Address - Phone:469-577-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ER ADDISON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care