Basic Information
| Provider Information | |||||||||
| NPI: | 1255768958 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGINIA EM-I MEDICAL SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18167 US HIGHWAY 19 N | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337643528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005078874 | ||||||||
| FaxNumber: | 7275362896 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ARH LANE | ||||||||
| Address2: | |||||||||
| City: | LOW MOOR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408626011 | ||||||||
| FaxNumber: | 5408626472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2013 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | BYRNE | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7703821530 | ||||||||
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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 | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363A00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.