Basic Information
| Provider Information | |||||||||
| NPI: | 1104151786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY PROFESSIONAL SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15070 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852675070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084219700 | ||||||||
| FaxNumber: | 4804219899 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N NAVAJO DR | ||||||||
| Address2: | |||||||||
| City: | PAGE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860409998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804219700 | ||||||||
| FaxNumber: | 4804219899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 299839 | 05 | AZ | MEDICAID |