Basic Information
| Provider Information | |||||||||
| NPI: | 1184674020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN TEXAS EMERGENCY PHYSICIANS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13737 NOEL ROAD | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 191012935 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 COGDELL BLVD | ||||||||
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| City: | SNYDER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795496162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732511132 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9732511132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0002NC | 01 | TX | BLUE SHIELD | OTHER | 177941501 | 05 | TX | MEDICAID |