MEDICARE: TENNESSEE EM-I MEDICAL SERVICES, PC

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	363L00000X	Nurse Practitioner
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1598198475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE EM-I MEDICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	18167 US HIGHWAY 19 N
Second Line	:	SUITE 650
City	:	CLEARWATER
State	:	FL
Zip	:	33764-3528
Country	:	US
Telephone Number	:	800-507-8874
Fax Number	:	727-536-2896

Provider Business Practice Location Address
First Line	:	313 N MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1347
Country	:	US
Telephone Number	:	615-792-3030
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY J. BYRNE
Credential	:	M.D.
Telephone Number	:	800-507-8874

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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