Basic Information
| Provider Information | |||||||||
| NPI: | 1336162726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY MEDICAL SERVICES GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82396 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933802396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613235918 | ||||||||
| FaxNumber: | 6613234703 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 EYE ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613235918 | ||||||||
| FaxNumber: | 6613234703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 05/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHIVINGTON | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6613235918 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 | GR0071550 | 05 | CA | MEDICAID | GR0071551 | 05 | CA | MEDICAID |