Basic Information
| Provider Information | |||||||||
| NPI: | 1063589539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS EM-1 MEDICAL SERVICES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 MAIN ST | ||||||||
| Address2: | SUITE 5200 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147122000 | ||||||||
| FaxNumber: | 2147122487 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 MEDICAL PKWY | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752347823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728887264 | ||||||||
| FaxNumber: | 2147122487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | JERNBERG | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2147122000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.