Basic Information
| Provider Information | |||||||||
| NPI: | 1861440646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GULF EMERGENCY MANAGEMENT, APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62600 | ||||||||
| Address2: | DEPT 1142 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701622600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106140180 | ||||||||
| FaxNumber: | 2105665698 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 HOUMA BLVD | ||||||||
| Address2: | EMERGENCY ROOM | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106140180 | ||||||||
| FaxNumber: | 2105665698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | WALES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRINCIPAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5404544196 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 1450847 | 05 | LA | MEDICAID | H4048Z | 01 | LA | BCBS | OTHER |