Provider Demographics
NPI:1619383791
Name:EMERGENCYMD
Entity Type:Organization
Organization Name:EMERGENCYMD
Other - Org Name:PRIMARYMD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BLASENAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-991-6156
Mailing Address - Street 1:2498 N. PLEASANTBURG DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609
Mailing Address - Country:US
Mailing Address - Phone:864-991-6156
Mailing Address - Fax:
Practice Address - Street 1:2498 N PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2730
Practice Address - Country:US
Practice Address - Phone:864-305-5000
Practice Address - Fax:864-840-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty