Basic Information
Provider Information
NPI: 1760434930
EntityType: 2
ReplacementNPI:  
OrganizationName: TENNESSEE EM-I MEDICAL SERVICES, P.C.
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Mailing Information
Address1: 815 S PALAFOX ST
Address2: STE 300
City: PENSACOLA
State: FL
PostalCode: 325025937
CountryCode: US
TelephoneNumber: 8004447009
FaxNumber: 8003053233
Practice Location
Address1: 400 E TICKLE ST
Address2:  
City: DYERSBURG
State: TN
PostalCode: 380243120
CountryCode: US
TelephoneNumber: 7312852410
FaxNumber: 8003053233
Other Information
ProviderEnumerationDate: 05/16/2006
LastUpdateDate: 02/16/2010
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: BYRNE
AuthorizedOfficialFirstName: GREGORY
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8003622731
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: M.D.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363L00000X  Y193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
371449405TN MEDICAID


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