MEDICARE: WEST VILLAGE 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	0065QC	OTHER	TX	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508059502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VILLAGE 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 E. LEMMON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2833
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	03/30/2023

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