Provider Demographics
NPI:1922577170
Name:EMCC PANTEGO PHYSICIANS PLLC
Entity Type:Organization
Organization Name:EMCC PANTEGO PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-830-8200
Mailing Address - Street 1:2300 MATLOCK RD STE 35
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5018
Mailing Address - Country:US
Mailing Address - Phone:469-830-8200
Mailing Address - Fax:469-830-8201
Practice Address - Street 1:1607 S BOWEN RD
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-3337
Practice Address - Country:US
Practice Address - Phone:817-421-0034
Practice Address - Fax:817-421-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty