Provider Demographics
NPI:1861440646
Name:GULF EMERGENCY MANAGEMENT, APMC
Entity Type:Organization
Organization Name:GULF EMERGENCY MANAGEMENT, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-454-4196
Mailing Address - Street 1:PO BOX 62600
Mailing Address - Street 2:DEPT 1142
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70162-2600
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-566-5698
Practice Address - Street 1:4200 HOUMA BLVD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:210-566-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1450847Medicaid
LAH4048ZOtherBCBS
LA5CQ90Medicare PIN
LA1450847Medicaid