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NPI Code Detail

MEDICARE: TRADITIONS EMERGENCY MEDICINE PA

MEDICARE: TRADITIONS EMERGENCY MEDICINE PA
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
1207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianTX

Other Identifiers

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

General Provider Information

NPI Number : 1396786232
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRADITIONS EMERGENCY MEDICINE PA
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 : 1604 ROCK PRAIRIE RD
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77845-8345
Country : US
Telephone Number : 979-764-5100
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM JERNBERG
Credential : MD
Telephone Number : 469-401-2386
Provider Enumeration Date : 06/10/2006
Last Update Date : 06/16/2014

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Practice Location Address:
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Directions to “TRADITIONS EMERGENCY MEDICINE PA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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