Healthcare Provider Details

I. General information

NPI: 1710591037
Provider Name (Legal Business Name): EMERGENCY MEDICAL SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FOUNTAIN FSED - MD 7890 FOUNTAIN MESA RD
FOUNTAIN CO
80817
US

IV. Provider business mailing address

PO BOX 173891
DENVER CO
80217-3891
US

V. Phone/Fax

Practice location:
  • Phone: 719-390-2680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY KAUP
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-210-1814