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NPI Code Detail

MEDICARE: COWBOY CAPITAL EMERGENCY PHYSICIANS

MEDICARE: COWBOY CAPITAL EMERGENCY PHYSICIANS
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
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10086MWOTHERTXBLUE SHIELD

General Provider Information

NPI Number : 1700839172
Entity Type Code : Organization
Provider Name (Legal Business Name) : COWBOY CAPITAL EMERGENCY PHYSICIANS
Provider Business Mailing Address
First Line : PO BOX 13560
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19101-3560
Country : US
Telephone Number : 214-712-2000
Fax Number : 214-712-2487
Provider Business Practice Location Address
First Line : 411 N BELKNAP ST
Second Line :
City : STEPHENVILLE
State : TX
Zip : 76401-3415
Country : US
Telephone Number : 254-965-1500
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM C JERNBERG
Credential :
Telephone Number : 214-712-2000
Provider Enumeration Date : 05/18/2006
Last Update Date : 04/20/2008

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Directions to “COWBOY CAPITAL EMERGENCY PHYSICIANS ” Practice Location

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