MEDICARE: NORTHBANK 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	208000000X	Pediatrics Physician
2	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0025NJ	OTHER	TX	BCBS GROUP

General Provider Information

NPI Number	:	1528019254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHBANK 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	:	1625 MEDICAL CENTER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5005
Country	:	US
Telephone Number	:	915-747-4000
Fax Number	:	214-712-2444

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH H. GATEWOOD
Credential	:	M.D.
Telephone Number	:	954-838-2371

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/21/2019

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