MEDICARE: SYMONS EMERGENCY SPECIALTIES, INC.

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	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590015099	OTHER		RRB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568462604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYMONS EMERGENCY SPECIALTIES, INC.

Provider Business Mailing Address
First Line	:	18592 CAJON BLVD
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-1604
Country	:	US
Telephone Number	:	909-880-2979
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 W LINE ST
Second Line	:
City	:	BISHOP
State	:	CA
Zip	:	93514-3448
Country	:	US
Telephone Number	:	760-873-8904
Fax Number	:	760-873-8449

Authorized Official
Title or Position	:	OWNER
Name	:	JUDD SYMONS
Credential	:
Telephone Number	:	760-873-8904

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/19/2012

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