Basic Information
| Provider Information | |||||||||
| NPI: | 1811942949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS EMERGENCY STAFFING SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD STE 1400 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729343200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 DIMMITT RD | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790721833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062965531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9729343200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 172441101 | 05 | TX | MEDICAID | 0046MN | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |