Provider Demographics
NPI:1982791554
Name:TEXAS EM-1 MEDICAL SERVICES, PA
Entity type:Organization
Organization Name:TEXAS EM-1 MEDICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:JERNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-712-2000
Mailing Address - Street 1:2606 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1804
Mailing Address - Country:US
Mailing Address - Phone:361-902-4000
Mailing Address - Fax:214-712-2067
Practice Address - Street 1:2606 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1804
Practice Address - Country:US
Practice Address - Phone:361-902-4000
Practice Address - Fax:214-712-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X547Medicare PIN