MEDICARE: CRYSTAL CITY EMERGENCY SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	426403	OTHER	MO	HEALTHLINK
2	124884	OTHER	MO	BLUE CROSS & BLUE SHIELD
3	137529	OTHER	MO	UMWA

General Provider Information

NPI Number	:	1801844618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CITY EMERGENCY SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 827431
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-7431
Country	:	US
Telephone Number	:	904-805-1300
Fax Number	:	904-805-1302

Provider Business Practice Location Address
First Line	:	HIGHWAY 61 SOUTH
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019
Country	:	US
Telephone Number	:	636-933-1000
Fax Number	:	904-805-1302

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	EUGENE DAUCHERT
Credential	:
Telephone Number	:	919-768-4392

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/11/2025

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Directions to “CRYSTAL CITY EMERGENCY SERVICES, LLC ” Practice Location

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