Provider Demographics
NPI:1487389136
Name:EMERGENCY SPECIALTY SERVICES LLC
Entity type:Organization
Organization Name:EMERGENCY SPECIALTY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-603-5324
Mailing Address - Street 1:1650 HOSPITAL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4794
Mailing Address - Country:US
Mailing Address - Phone:505-670-1976
Mailing Address - Fax:505-983-7212
Practice Address - Street 1:1650 HOSPITAL DR STE 500
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4794
Practice Address - Country:US
Practice Address - Phone:505-670-1976
Practice Address - Fax:505-983-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41588525Medicaid