MEDICARE: TEXAS EM-1 MEDICAL SERVICES, PA

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1164475216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS EM-1 MEDICAL SERVICES, PA

Provider Business Mailing Address
First Line	:	PO BOX 41414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-1414
Country	:	US
Telephone Number	:	214-712-2000
Fax Number	:	214-712-2487

Provider Business Practice Location Address
First Line	:	4400 NEW YORK AVE
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-4817
Country	:	US
Telephone Number	:	817-395-5100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM C JERNBERG
Credential	:	MD
Telephone Number	:	214-712-2000

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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