Basic Information
| Provider Information | |||||||||
| NPI: | 1942638242 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELECTRICAL MEDICINE FOUNDATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1606 WYNN JOYCE RD | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750433266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723030683 | ||||||||
| FaxNumber: | 9723039683 | ||||||||
| Practice Location | |||||||||
| Address1: | 1606 WYNN JOYCE RD | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750433266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723030683 | ||||||||
| FaxNumber: | 9723039683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUNK | ||||||||
| AuthorizedOfficialFirstName: | DARCY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9723030683 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 1001192 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.