Basic Information
| Provider Information | |||||||||
| NPI: | 1215975396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY SERVICE STAFFING PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 W 34TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
| FaxNumber: | 5124529306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 FRANCISCAN DR | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778022544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797763777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5124528533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | DE8976 | 01 | TX | RAILROAD MEDICARE | OTHER | 0022DJ | 01 | TX | BCBS | OTHER |