Emergency Professional Services, PC

Organization Active NPI Emergency Medicine Physician · Page, AZ

NPI 1104151786 · NPPES record last updated Sep 24, 2019

Key facts

NPI
1104151786
Entity type
Organization (NPI type 2)
Primary specialty
Emergency Medicine Physician 207P00000X
Legal business name
EMERGENCY PROFESSIONAL SERVICES, PC
Practice address
501 N Navajo Dr
Page, AZ 86040-9998
Phone
(480) 421-9700
Fax
(480) 421-9899
NPI assigned
Oct 15, 2009
Organization subpart
No

Authorized official

Name
Kathy Kondas
Title
Officer
Phone
(954) 838-2371

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 6

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AZ

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040119000693 AZ Part B Supplier - Clinic/Group Practice 6901707272 Receives reassigned benefits from 255 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Apache Junction, AZ; Phoenix, AZ; San Tan Valley, AZ

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207P00000X Yes

Addresses

Primary practice location

501 N Navajo Dr
Page, AZ 86040-9998

Mailing address

PO Box 15070
Scottsdale, AZ 85267-5070
Phone (408) 421-9700

Other identifiers

IdentifierTypeStateIssuer
299839MedicaidAZ

Other providers in Page, AZ

All providers in Page, AZ · Emergency Medicine Physician in Arizona

Sources for this page

Verify at the official NPI Registry.