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NPI Code Detail

MEDICARE: WATERCANAL ER SVCS PARTNERSHIP LLC

MEDICARE: WATERCANAL ER SVCS PARTNERSHIP 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
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
272262OTHERFLBLUE SHIELD

General Provider Information

NPI Number : 1073561379
Entity Type Code : Organization
Provider Name (Legal Business Name) : WATERCANAL ER SVCS PARTNERSHIP LLC
Provider Business Mailing Address
First Line : 13737 NOEL RD
Second Line : STE 1600
City : DALLAS
State : TX
Zip : 75240-1331
Country : US
Telephone Number : 469-401-2386
Fax Number : 214-712-2444
Provider Business Practice Location Address
First Line : 60 MEMORIAL MEDICAL PKWY
Second Line :
City : PALM COAST
State : FL
Zip : 32164-5980
Country : US
Telephone Number : 386-586-2010
Fax Number : 386-676-4248
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOSEPH H. GATEWOOD
Credential : M.D.
Telephone Number : 469-401-2386
Provider Enumeration Date : 05/05/2006
Last Update Date : 06/20/2014

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Directions to “WATERCANAL ER SVCS PARTNERSHIP LLC ” Practice Location

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