Provider Demographics
NPI:1568489243
Name:WEST SOUND EMERGENCY PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:WEST SOUND EMERGENCY PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:TESAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-341-4512
Mailing Address - Street 1:PO BOX 920135
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0135
Mailing Address - Country:US
Mailing Address - Phone:877-346-2211
Mailing Address - Fax:626-623-1227
Practice Address - Street 1:1800 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7663
Practice Address - Country:US
Practice Address - Phone:626-447-0296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013475Medicaid
WA7133911Medicaid