Provider Demographics
NPI:1134321888
Name:TACOMA EMERGENCY MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:TACOMA EMERGENCY MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT NEP CMO TEAMHEALTH
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:LASALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-336-8614
Mailing Address - Street 1:PO BOX 634720
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6660
Practice Address - Fax:253-426-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACE1810Medicare PIN
WAGAB13804Medicare PIN