Basic Information
| Provider Information | |||||||||
| NPI: | 1861052722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMCC CORPUS MIDTOWN ER PROFESSIONAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 RIDGEVIEW DR. STE 140-114 | ||||||||
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| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750135543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143907697 | ||||||||
| FaxNumber: | 9724326692 | ||||||||
| Practice Location | |||||||||
| Address1: | 4117 S STAPLES ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784115506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618551121 | ||||||||
| FaxNumber: | 3615004291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | NEWSOM | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4698308200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.