Basic Information
| Provider Information | |||||||||
| NPI: | 1033593504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY STAFFING SOLUTIONS OF WEST TEXAS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 COLLEGE AVE | ||||||||
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| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793366508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068944963 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | WAY | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8669318882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.