Provider Demographics
NPI:1881646701
Name:TEXAS EM-I MEDICAL SERVICES, PA
Entity Type:Organization
Organization Name:TEXAS EM-I MEDICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-450-4684
Mailing Address - Street 1:13737 NOEL RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1374
Mailing Address - Country:US
Mailing Address - Phone:973-251-1132
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5674
Practice Address - Country:US
Practice Address - Phone:979-297-4411
Practice Address - Fax:214-712-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152242708Medicaid
TX00778ZMedicare PIN