MEDICARE: BAYSIDE EMERGENCY PHYSICIANS, LLP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1578598736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE EMERGENCY PHYSICIANS, LLP

Provider Business Mailing Address
First Line	:	PO BOX 849890
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-9890
Country	:	US
Telephone Number	:	800-701-3381
Fax Number	:	239-939-1682

Provider Business Practice Location Address
First Line	:	1311 GENERAL CAVAZOS BLVD
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-7129
Country	:	US
Telephone Number	:	361-595-1661
Fax Number	:

Authorized Official
Title or Position	:	LLP MANAGING PARTNER
Name	:	DR. JAMES M JOHNSON
Credential	:	M.D.
Telephone Number	:	800-253-5358

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	04/02/2008

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