Provider Demographics
NPI:1205935707
Name:SUBURBAN EMERGENCY CENTER
Entity type:Organization
Organization Name:SUBURBAN EMERGENCY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-679-5600
Mailing Address - Street 1:12345 KATY FREEWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1503
Mailing Address - Country:US
Mailing Address - Phone:281-679-5600
Mailing Address - Fax:281-759-5379
Practice Address - Street 1:12345 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1503
Practice Address - Country:US
Practice Address - Phone:281-679-5600
Practice Address - Fax:281-759-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8428KOMedicare UPIN
TX888152Medicare UPIN
TX888151Medicare UPIN
TX8DO235Medicare UPIN
TX8G1198Medicare UPIN
TX85052JMedicare UPIN
TX888160Medicare UPIN
TX8A0707Medicare UPIN
TX8G1199Medicare UPIN
TX888173Medicare UPIN
TX888166Medicare UPIN