Organization Active NPI

Fidem Emergency Partners PLLC

  • Emergency Medicine Physician
  • Spring, TX
National Provider Identifier
1528465242
Registry record updated Dec 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
FIDEM EMERGENCY PARTNERS PLLC
Practice address
20635 Kuykendahl Rd
Spring, TX 77379-3533
Phone
(281) 363-7170
Fax
(281) 763-2694
NPI assigned
Nov 24, 2014
Last updated
Dec 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Derrick Anthony Mitchell, M.D.
Title
Administrator
Phone
(936) 524-8049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

20635 Kuykendahl Rd
Spring, TX 77379-3533

Mailing address

20635 Kuykendahl Rd
Spring, TX 77379-3533
Phone (281) 363-7170

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419120000000",
    "number": "1528465242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20635 KUYKENDAHL RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773793533",
            "telephone_number": "281-363-7170",
            "fax_number": "281-763-2694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20635 KUYKENDAHL RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773793533",
            "telephone_number": "281-363-7170",
            "fax_number": "281-763-2694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIDEM EMERGENCY PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-24",
        "last_updated": "2014-12-21",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "936-524-8049",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.