MEDICARE: CAROLINE EMERGENCY PHYSICIANS PLLC

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
1	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0042JF	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1437109618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINE EMERGENCY PHYSICIANS PLLC

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	:	1313 HERMANN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7005
Country	:	US
Telephone Number	:	713-527-5129
Fax Number	:	713-527-5954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM C. JERNBERG
Credential	:	MD
Telephone Number	:	469-401-2386

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	12/22/2013

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