Provider Demographics
NPI:1285928036
Name:EVIDENCE MEDICAL TECHNOLOGIES EMT
Entity type:Organization
Organization Name:EVIDENCE MEDICAL TECHNOLOGIES EMT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-814-8681
Mailing Address - Street 1:1208 LAKE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4016
Mailing Address - Country:US
Mailing Address - Phone:469-814-8681
Mailing Address - Fax:469-814-8268
Practice Address - Street 1:1008 WINSCOTT RD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2778
Practice Address - Country:US
Practice Address - Phone:469-814-8681
Practice Address - Fax:469-814-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty