MEDICARE: TEXAS EM-1MEDICAL SERVICES, PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1831149012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS EM-1MEDICAL SERVICES, PA

Provider Business Mailing Address
First Line	:	PO BOX 13972
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-3972
Country	:	US
Telephone Number	:	800-444-7009
Fax Number	:	800-305-3233

Provider Business Practice Location Address
First Line	:	801 N BEDELL AVE
Second Line	:	EMERGENCY DEPARTMENT
City	:	DEL RIO
State	:	TX
Zip	:	78840-4112
Country	:	US
Telephone Number	:	830-703-1702
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM A JERNBERG
Credential	:	M.D.
Telephone Number	:	800-444-7009

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/24/2008

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