Basic Information
| Provider Information | |||||||||
| NPI: | 1548216286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST PASCO EMERGENCY CONSULTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41622 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191011622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1800355381 | ||||||||
| FaxNumber: | 6108342862 | ||||||||
| Practice Location | |||||||||
| Address1: | 7050 GALL BLVD | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335411347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137836111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILCHER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8137836112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 98761 | 01 | FL | BLUE SHIELD | OTHER |