Organization · NPI-2

22250 Bulverde Cec Fossil Creek LLC

Clinic/Center, Emergency Care · San Antonio, TX

NPI number1740603422
StatusActive
Last updated in NPPESFeb 10, 2022

Details

NPI
1740603422
Entity type
Organization (NPI-2)
Legal business name
22250 Bulverde Cec Fossil Creek LLC
Organization subpart
No
Enumeration date
Jan 30, 2014
Certification date
Feb 10, 2022
Last updated
Feb 10, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QE0002X Clinic/Center, Emergency Care––Yes

Other names

  • Fossil Creek Complete Care (Doing Business As)

Practice location

22250 Bulverde Rd
120
San Antonio, TX 78261-3084

Phone 817-421-0034 · Fax 817-421-0036

Mailing address

Po Box 93059
Southlake, TX 76092-1059

Phone 817-421-0034 · Fax 817-421-0036

Authorized official

Julie Radley
Coo
7135912256

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