MEDICARE: EMERGENCY PROFESSIONAL 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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1902936164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY PROFESSIONAL SERVICES PC

Provider Business Mailing Address
First Line	:	PO BOX 202332
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-2332
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Provider Business Practice Location Address
First Line	:	37000 N GANTZEL RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7303
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER KENNEDY
Credential	:
Telephone Number	:	207-807-9009

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	05/29/2026

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