MEDICARE: FLAMINGO EMERGENCY PHYSICIANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	363L00000X	Nurse Practitioner
2	363A00000X	Physician Assistant
3	207P00000X	Emergency Medicine Physician	NV

General Provider Information

NPI Number	:	1962573667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAMINGO EMERGENCY PHYSICIANS

Provider Business Mailing Address
First Line	:	3916 STATE ST
Second Line	:	#300
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-5602
Country	:	US
Telephone Number	:	805-563-3011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5188
Country	:	US
Telephone Number	:	702-369-7647
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. EDWIN HOMANSKY
Credential	:	MD
Telephone Number	:	805-563-3011

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/30/2009

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