Healthcare Provider Details

I. General information

NPI: 1114199650
Provider Name (Legal Business Name): PROFESSIONAL EMERGENCY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N 28TH ST
RICHMOND VA
23223-5332
US

IV. Provider business mailing address

2987 MOMENTUM PL
CHICAGO IL
60689-5329
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-1780
  • Fax: 804-225-1705
Mailing address:
  • Phone: 734-805-0477
  • Fax: 866-250-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TOMMI A. WHITE
Title or Position: CEO
Credential:
Phone: 734-632-0175