Provider Demographics
NPI:1265966626
Name:C3ERLAS1,PLLC
Entity type:Organization
Organization Name:C3ERLAS1,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-320-9820
Mailing Address - Street 1:5300 TOWN AND COUNTRY BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6894
Mailing Address - Country:US
Mailing Address - Phone:469-320-9820
Mailing Address - Fax:
Practice Address - Street 1:5757 WAYNE NEWTON BLVD
Practice Address - Street 2:TERMINAL 1, 2ND FLOOR
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89111
Practice Address - Country:US
Practice Address - Phone:702-846-0020
Practice Address - Fax:702-846-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care