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Organization
TEXAS EM-I MEDICAL SERVICE, PA
Active
Organization
TEXAS EM-I MEDICAL SERVICE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
1000 MONTGOMERY ST, FT WORTH, TX 76107-2625
(817) 795-2100
Mailing address
PO BOX 41426, PHILADELPHIA, PA 19101-1426
(800) 355-0808
(215) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
07/05/2007
Last updated
08/22/2020
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