Organization
BONITA CREEK EMERGENCY SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM CORLEY MD (PRESIDENT)
(337) 277-6355
Entity
Organization
Contact information
Practice address
1204 N MOUND ST, NACOGDOCHES, TX 75961-4027
(936) 564-4611
Mailing address
638A N UNIVERSITY DR # 184, NACOGDOCHES, TX 75961-4617
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345
MEDICAID
TX
Enumeration date
03/22/2022
Last updated
01/09/2023
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