Provider Demographics
NPI:1528029196
Name:EMERGENCY MEDICAL SERVICES GROUP, PA
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL SERVICES GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-441-5011
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:ER DEPT.
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-5011
Practice Address - Fax:405-749-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100727020AMedicaid
AR172165800OtherDEPT. OF LABOR
AR105698002Medicaid
MS04705239Medicaid
ARCG7720Medicare PIN
AR172165800OtherDEPT. OF LABOR