Organization Name: | PROFESSIONAL EMERGENCY SERVICE ASSOCIATION OF DESOTO |
NPI Number: | 1114072550 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY P. ENNIS (MEDICAL DIRECTOR) |
Mailing Address: | 911 N Hampton Rd Suite 120 Desoto |
State: | TX US |
Postal Code: | 751153903 |
Phone Number: | 9722830444 |
Fax Number: | 9722834484 |
NPI Enumeration Date: | 01/24/2007 |
NPI Last Update Date: | 10/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |