Healthcare Provider Details

I. General information

NPI: 1457890402
Provider Name (Legal Business Name): TOWN SQUARE EMERGENCY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 HILLSIDE RD
AMARILLO TX
79119-7323
US

IV. Provider business mailing address

5121 MARYLAND WAY STE 300
BRENTWOOD TN
37027-7516
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-4208
  • Fax: 817-563-3699
Mailing address:
  • Phone: 855-246-8607
  • Fax: 629-216-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK6339
License Number StateTX

VIII. Authorized Official

Name: JAMES GRIMES
Title or Position: CFO
Credential:
Phone: 615-922-4718