Healthcare Provider Details

I. General information

NPI: 1447878749
Provider Name (Legal Business Name): EMER MESQUITE GUS THOMASSON PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 GUS THOMASSON RD
MESQUITE TX
75150-3627
US

IV. Provider business mailing address

2300 MATLOCK RD STE 35
MANSFIELD TX
76063-5018
US

V. Phone/Fax

Practice location:
  • Phone: 972-682-7961
  • Fax: 972-682-7964
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 NEWSON
Title or Position: PRESIDENT
Credential:
Phone: 469-830-8200