Healthcare Provider Details

I. General information

NPI: 1134859325
Provider Name (Legal Business Name): EMERGENCY SERVICES PROVIDER GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NE 6TH ST UNIT 2112
POMPANO BEACH FL
33060-6541
US

IV. Provider business mailing address

PO BOX 2112
POMPANO BEACH FL
33061-2112
US

V. Phone/Fax

Practice location:
  • Phone: 561-508-8555
  • Fax:
Mailing address:
  • Phone: 405-921-6935
  • Fax: 888-323-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MALIK LEIGH
Title or Position: CEO
Credential:
Phone: 561-508-8555