Healthcare Provider Details
I. General information
NPI: 1558912345
Provider Name (Legal Business Name): DAVIS EMERGENCY MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1000 S MAIN ST
SHAMROCK TX
79079-2820
US
IV. Provider business mailing address
PO BOX 8337
AMARILLO TX
79114-8337
US
V. Phone/Fax
- Phone: 806-216-1446
- Fax:
- Phone: 806-355-6593
- Fax: 806-352-8774
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
WILLIAM
M
DAVIS
Title or Position: MBR
Credential: MD
Phone: 806-216-1446