Organization
WILD RIVERS EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(973) 251-1132
(541) 247-3118
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500637245
—
OR
01
—
616164500
US DEPT OF LABOR
OR
01
—
DS0356
RAILROAD MEDICARE
OR
Enumeration date
06/24/2011
Last updated
12/05/2019
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