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General NPI Number Information
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NPI Number | 1215418280
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Entity Type | Organization
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Legal Business Name | EMERGENCY ASSOCIATES OF CENTRAL TEXAS PA
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 2201 S CLEAR CREEK RD
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone | 865-693-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 265 BROOKVIEW CENTRE WAY STE 400
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City | KNOXVILLE
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State | TN
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Zip | 37919-4052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PROVIDER ENROLLMENT
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Name | SHARON HARDY
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Credential |
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Telephone | 925-251-6901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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