Healthcare Provider Details

I. General information

NPI: 1831717677
Provider Name (Legal Business Name): EMER GRAND PRAIRIE PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W JEFFERSON ST
GRAND PRAIRIE TX
75051-1557
US

IV. Provider business mailing address

2300 MATLOCK RD STE 35
MANSFIELD TX
76063-5018
US

V. Phone/Fax

Practice location:
  • Phone: 214-518-6055
  • Fax: 214-518-6071
Mailing address:
  • Phone: 469-830-8200
  • Fax: 469-830-8201

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: MICHELLE NEWSOM
Title or Position: PRESIDENT
Credential:
Phone: 469-830-8200