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NPI Code Detail

MEDICARE: WAYNESBORO EMERGENCY SERVICES II, LLC

MEDICARE: WAYNESBORO EMERGENCY SERVICES II, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3207P00000XEmergency Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3DC2765OTHERTNRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1154004300OTHERTNDEPT OF LABOR
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013965516
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAYNESBORO EMERGENCY SERVICES II, LLC
Provider Business Mailing Address
First Line : PO BOX 534114
Second Line :
City : ATLANTA
State : GA
Zip : 30353-4114
Country : US
Telephone Number : 904-805-1300
Fax Number : 904-805-1302
Provider Business Practice Location Address
First Line : 103 JV MANGUBAT DR
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-2440
Country : US
Telephone Number : 931-722-5411
Fax Number : 904-805-1302
Authorized Official
Title or Position : CHAIRMAN/PRESIDENT/CEO
Name : ROBERT J BUNKER
Credential :
Telephone Number : 904-805-1300
Provider Enumeration Date : 05/05/2006
Last Update Date : 07/23/2008

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