1750360061 NPI number — EMERGENCY MANAGEMENT ASSOCIATES PC

Table of content: (NPI 1750360061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750360061 NPI number — EMERGENCY MANAGEMENT ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY MANAGEMENT ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750360061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66225-5277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-307-6920
Provider Business Mailing Address Fax Number:
918-307-6951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10501 E 91ST ST
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-5790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-307-6920
Provider Business Practice Location Address Fax Number:
918-307-6951
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
918-307-6950

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100745790A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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