Provider Demographics
NPI:1134237134
Name:EMERGENCY MEDICAL SERVICES GROUP
Entity type:Organization
Organization Name:EMERGENCY MEDICAL SERVICES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-323-5918
Mailing Address - Street 1:3550 Q ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1662
Mailing Address - Country:US
Mailing Address - Phone:661-323-5918
Mailing Address - Fax:661-323-4703
Practice Address - Street 1:100 E NORTH ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3606
Practice Address - Country:US
Practice Address - Phone:661-765-1935
Practice Address - Fax:661-765-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071551Medicaid
CAZZZ27961ZMedicare PIN