NPIMap

Organization Active NPI

Watercanal ER SVCS Partnership LLC

  • Emergency Medicine Physician
  • Palm Coast, FL
National Provider Identifier
1073561379
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WATERCANAL ER SVCS PARTNERSHIP LLC
Practice address
60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980
Phone
(386) 586-2010
Fax
(386) 676-4248
NPI assigned
May 5, 2006
Last updated
Jun 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

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

Authorized official

Name
Dr. Joseph H. Gatewood, M.D.NPI 1063407963
Title
President
Phone
(469) 401-2386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980

Mailing address

13737 Noel Rd
Ste 1600
Dallas, TX 75240-1331
Phone (469) 401-2386

Other identifiers 2

IdentifierTypeStateIssuer
72262OtherFLBLUE SHIELD
275953500MedicaidFL

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, and the practitioner matching its NPPES authorized official.

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": "1403222400000",
    "number": "1073561379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331",
            "telephone_number": "469-401-2386",
            "fax_number": "214-712-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MEMORIAL MEDICAL PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321645980",
            "telephone_number": "386-586-2010",
            "fax_number": "386-676-4248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERCANAL ER SVCS PARTNERSHIP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2014-06-20",
        "status": "A",
        "authorized_official_last_name": "GATEWOOD",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-401-2386",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "72262",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275953500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; 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.