Organization
HEB EMERGICARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN PECKENPAUGH MD (PRESIDENT)
(817) 685-4619
Entity
Organization
Contact information
Practice address
2700 TIBBETS DR, SUITE #210, BEDFORD, TX 76022-5928
(817) 354-5600
Mailing address
P O BOX 960046, OKLAHOMA CITY, OK 73196-0001
(877) 485-4474
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00L58L
BCBS
TX
05
—
112655902
—
TX
05
—
112655904
—
TX
01
—
1306812193
GROUP NPI
—
01
—
CQ3073
RAILROAD MEDICARE
TX
Enumeration date
02/23/2006
Last updated
04/29/2014
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