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General NPI Number Information
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NPI Number | 1619379534
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Entity Type | Organization
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Legal Business Name | ILLINOIS/INDIANA EM-I MEDICAL SERVICES, SC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 1324 N SHERIDAN RD
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City | WAUKEGAN
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State | IL
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Zip | 60085-2161
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Country | US
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Telephone | 847-360-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone | 469-401-2386
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Fax | 214-712-2444
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS WEBSTER
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Credential | DO
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Telephone | 469-401-2386
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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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