MEDICARE: E MEDICAL GROUP OF TEXAS NO 1 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1073135927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E MEDICAL GROUP OF TEXAS NO 1 LLC

Provider Business Mailing Address
First Line	:	2301 FM 1187
Second Line	:	SUITE 203
City	:	MANSFIELD
State	:	TX
Zip	:	76063
Country	:	US
Telephone Number	:	817-469-6739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 SANTA FE DR STE 101
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5859
Country	:	US
Telephone Number	:	817-807-0224
Fax Number	:	817-602-7476

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	ANGELA EDDINS
Credential	:
Telephone Number	:	817-469-6739

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	02/26/2025

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