Healthcare Provider Details

I. General information

NPI: 1295780757
Provider Name (Legal Business Name): TEXAS EM-1 MEDICAL SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 I-30
MESQUITE TX
75150
US

IV. Provider business mailing address

1717 MAIN ST SUITE 5200
DALLAS TX
75201-4605
US

V. Phone/Fax

Practice location:
  • Phone: 972-698-3300
  • Fax:
Mailing address:
  • Phone: 214-712-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM C JERNBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 214-712-2000