MEDICARE: PHYSICIAN ACUTE CARE SERVICES PLANO, 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	H000J1Z101	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1689128217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN ACUTE CARE SERVICES PLANO, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	NEW WAVERLY
State	:	TX
Zip	:	77358-0190
Country	:	US
Telephone Number	:	936-525-9216
Fax Number	:	713-808-9176

Provider Business Practice Location Address
First Line	:	2000 DALLAS PKWY
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75093-4312
Country	:	US
Telephone Number	:	972-378-7878
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	PATRICIA SHORT
Credential	:	M.D.
Telephone Number	:	936-525-9216

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	05/02/2018

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