Provider Demographics
NPI:1962453860
Name:EMERGENCY MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:EMERGENCY MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-514-2142
Mailing Address - Street 1:PO BOX 742997
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2997
Mailing Address - Country:US
Mailing Address - Phone:781-280-1773
Mailing Address - Fax:781-280-1814
Practice Address - Street 1:600 NE 92ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3225
Practice Address - Country:US
Practice Address - Phone:360-514-2000
Practice Address - Fax:360-514-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601287343207P00000X
261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128507Medicaid
OR278137Medicaid
WADE1747OtherRAILROAD MEDICARE
WADE1747OtherRAILROAD MEDICARE