=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770596934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILBERT EMERGENCY MEDICINE SPECIALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 09/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5656 S POWER RD GILBERT HOSPITAL
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-984-2000
-----------------------------------------------------
Fax | 480-279-5836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5656 S POWER RD
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85295-8487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-984-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | TIMOTHY A JOHNS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-984-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------