Organization
REPUBLIC EMERGENCY SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN B STACKS MD (PRESIDENT)
(903) 870-4609
Entity
Organization
Contact information
Practice address
500 N HIGHLAND AVE, SHERMAN, TX 75092-7354
(903) 870-4609
Mailing address
PO BOX 24921, FORT WORTH, TX 76124-1921
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U33U
BLUE CROSS BLUE SHIELD
TX
05
—
170359701
—
TX
Enumeration date
05/10/2006
Last updated
07/17/2008
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