MEDICARE: CANEY RUN 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
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1851610737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANEY RUN EMERGENCY PHYSICIANS

Provider Business Mailing Address
First Line	:	PO BOX 98572
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8572
Country	:	US
Telephone Number	:	800-444-7009
Fax Number	:	800-305-3233

Provider Business Practice Location Address
First Line	:	10141 US 59 RD
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-7224
Country	:	US
Telephone Number	:	979-532-2500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH H. GATEWOOD
Credential	:	M.D.
Telephone Number	:	214-712-2000

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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