1881067361 NPI number — VERSACARE EMERGENCY MEDICAL SERVICES, INC

Table of content: DR. JAMES DOMINIC BRUE MD (NPI 1710053467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881067361 NPI number — VERSACARE EMERGENCY MEDICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERSACARE EMERGENCY MEDICAL SERVICES, INC
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:
6
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:
1881067361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8519 EL MODENA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELVERTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95626-9572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-521-0966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8519 EL MODENA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELVERTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95626-9572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-521-0966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
LINDA
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
916-521-0966

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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