MEDICARE: EMERGENT TESTING OF TEXAS PLLC

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	:	1932787355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENT TESTING OF TEXAS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 5518
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30604-5518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7133 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-6606
Country	:	US
Telephone Number	:	404-999-7978
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	JONATHAN GOSS
Credential	:	MD
Telephone Number	:	713-819-6417

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	10/05/2021

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