Basic Information
| Provider Information | |||||||||
| NPI: | 1194930040 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EMCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11235 OAK LEAF DR APT # 1515 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102601290 | ||||||||
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| Practice Location | |||||||||
| Address1: | PHS INDIAN HOSPITAL HWY 1 PO 497 | ||||||||
| Address2: | |||||||||
| City: | RED LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186793912 | ||||||||
| FaxNumber: | 2186790181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 09/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8004447009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MANAGER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | D0065884 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.