Healthcare Provider Details

I. General information

NPI: 1306812193
Provider Name (Legal Business Name): HEB EMERGICARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 TIBBETS DR SUITE #210
BEDFORD TX
76022-5928
US

IV. Provider business mailing address

P O BOX 960046
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 817-354-5600
  • Fax:
Mailing address:
  • Phone: 877-485-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN PECKENPAUGH
Title or Position: PRESIDENT
Credential: MD
Phone: 817-685-4619