Basic Information
| Provider Information | |||||||||
| NPI: | 1164645297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER CITY EMERGENCY PHYSICIANS, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RIVER CITY EMERGENCY PHYSICIANS, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12740 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926852740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624680227 | ||||||||
| FaxNumber: | 5624670865 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 DALLAS ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782051201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102977000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 09/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2104959860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 194396101 | 05 | TX | MEDICAID | 0130NY | 01 | TX | BCBCTX | OTHER |