Healthcare Provider Details

I. General information

NPI: 1003930686
Provider Name (Legal Business Name): NEW JERSEY/PENNSYLVANIA EM-I MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

IV. Provider business mailing address

1717 MAIN ST SUITE 5200
DALLAS TX
75201-4612
US

V. Phone/Fax

Practice location:
  • Phone: 717-625-5000
  • Fax:
Mailing address:
  • Phone: 214-712-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RUSSELL HARRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 215-442-5000