Provider Demographics
NPI:1932430295
Name:BARTLETT EMERGENCY GROUP, PA
Entity type:Organization
Organization Name:BARTLETT EMERGENCY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-631-2178
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-0055
Mailing Address - Country:US
Mailing Address - Phone:432-631-2178
Mailing Address - Fax:432-558-7064
Practice Address - Street 1:1330 EAST 8TH STREET
Practice Address - Street 2:SUITE #310
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-631-2178
Practice Address - Fax:432-558-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1865207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105516Medicare PIN