# E-DOC URGENT CARE CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396097945
- **Authorized official:** MR. SRINIVAS GURRAM REDDY (PRESIDENT)
- **Authorized official phone:** (817) 808-3443

## Contact information

- **Practice address:** 651 N DENTON TAP RD, SUITE 100, COPPELL, TX 75019-2007
- **Practice address phone:** (817) 332-6644
- **Practice address fax:** (817) 887-5522
- **Mailing address:** 2810 BROOKSHIRE DR, SOUTHLAKE, SOUTHLAKE, TX 76092-8933
- **Mailing address phone:** (817) 332-6644
- **Mailing address fax:** (817) 887-5522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/05/2012
- **Last updated:** 10/05/2012