Healthcare Provider Details

I. General information

NPI: 1609154335
Provider Name (Legal Business Name): LIPSCOMB EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LIPSCOMB ST
BONHAM TX
75418-4028
US

IV. Provider business mailing address

815 S PALAFOX ST STE 300
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-8585
  • Fax: 903-640-7601
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-302-3233

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: JOSEPH H GATEWOOD
Title or Position: PRESIDENT, TERS, GENERAL PARTNER
Credential: MD
Phone: 800-444-7009