Basic Information
| Provider Information | |||||||||
| NPI: | 1962453860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY MEDICINE ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742997 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900742997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812801773 | ||||||||
| FaxNumber: | 7812801814 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 NE 92ND AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986643225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605142000 | ||||||||
| FaxNumber: | 3605146820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | GORECKI | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3605142142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 207P00000X | 601287343 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7128507 | 05 | WA | MEDICAID | 278137 | 05 | OR | MEDICAID | DE1747 | 01 | WA | RAILROAD MEDICARE | OTHER |