Provider On Demand LLC

NPI #1013770148 in Lorena, Texas

Provider Information

NPI Number: 1013770148
Entity Type: Organization
Organization Name: Provider On Demand LLC
Primary Specialty: Emergency Medicine
Enumeration Date: Feb 1, 2024
Last Updated: Oct 9, 2024

Practice Location

Address: 1199 OLD LORENA RD
City: Lorena
State: Texas
ZIP Code: 76655-3176
Phone: (757) 642-5062

Authorized Official

Name: DR. BRETT MARVEL, MD
Title: COO
Phone: (737) 747-2200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X
Nurse Practitioner - Family — Family	363LF0000X
Emergency Medicine	207P00000X	Primary

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