MEDICARE: EMERGENCY CARE DYNAMICS INC

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	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972505857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY CARE DYNAMICS INC

Provider Business Mailing Address
First Line	:	3434 MIDWAY DR STE 1002
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4924
Country	:	US
Telephone Number	:	619-225-6200
Fax Number	:	619-225-6208

Provider Business Practice Location Address
First Line	:	3434 MIDWAY DR
Second Line	:	STE 1002
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4923
Country	:	US
Telephone Number	:	619-225-6200
Fax Number	:	619-225-6208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK J TAMSEN
Credential	:	MD
Telephone Number	:	619-225-6200

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/22/2023

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