NPIMap

Organization Active NPI

Waynesboro Emergency Services II, LLC

  • Emergency Medicine Physician
  • Waynesboro, TN
National Provider Identifier
1013965516
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WAYNESBORO EMERGENCY SERVICES II, LLC
Practice address
103 JV Mangubat Dr
Waynesboro, TN 38485-2440
Phone
(931) 722-5411
Fax
(904) 805-1302
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert J Bunker
Title
Chairman/President/Ceo
Phone
(904) 805-1300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

103 JV Mangubat Dr
Waynesboro, TN 38485-2440

Mailing address

PO Box 534114
Atlanta, GA 30353-4114
Phone (904) 805-1300

Other identifiers 3

IdentifierTypeStateIssuer
154004300OtherTNDEPT OF LABOR
3727708MedicaidTN
DC2765OtherTNRAIL ROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1013965516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 534114",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303534114",
            "telephone_number": "904-805-1300",
            "fax_number": "904-805-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 JV MANGUBAT DR",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384852440",
            "telephone_number": "931-722-5411",
            "fax_number": "904-805-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNESBORO EMERGENCY SERVICES II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "BUNKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHAIRMAN/PRESIDENT/CEO",
        "authorized_official_telephone_number": "904-805-1300"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "154004300",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3727708",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DC2765",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.