MEDICARE: ALFONSINO EMERGENCY PHYSICIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	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

General Provider Information

NPI Number	:	1598169823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFONSINO EMERGENCY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	973-251-1132
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-4102
Country	:	US
Telephone Number	:	954-838-2371
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	973-251-1132

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	12/05/2019

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