Basic Information
| Provider Information | |||||||||
| NPI: | 1407845092 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEMECULA VALLEY EMERGENCY MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7725 W RENO AVE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731279742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009623303 | ||||||||
| FaxNumber: | 3059290765 | ||||||||
| Practice Location | |||||||||
| Address1: | 28062 BAXTER RD | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925631401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512904108 | ||||||||
| FaxNumber: | 9512904944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | BAUGH | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER/FINANCIAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9516962850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | GR0063700 | 05 | CA | MEDICAID |