NPIMap

Organization Active NPI

Professional Emergency Service Association of Desoto

  • Occupational Medicine Clinic/Center
  • Desoto, TX
National Provider Identifier
1114072550
Registry record updated Oct 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
PROFESSIONAL EMERGENCY SERVICE ASSOCIATION OF DESOTO
Practice address
911 N Hampton Rd
Suite 120
Desoto, TX 75115-3903
Phone
(972) 283-0444
Fax
(972) 283-4484
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2013

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

Authorized official

Name
Gregory P. Ennis, M.D.NPI 1619092228
Title
Medical Director
Phone
(972) 659-1234

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

911 N Hampton Rd
Suite 120
Desoto, TX 75115-3903

Mailing address

PO Box 153068
Irving, TX 75015-3068
Phone (972) 659-1234

Other names 1

  • EcCare Health Center of DeSoto Other name

National Provider Directory

National Provider Directory

Locations

911 N Hampton Rd
Ste 120
Desoto, TX 75115
Phone (972) 659-1234

Practitioners & affiliated clinicians

Practitioners 4

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382918400000",
    "number": "1114072550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 153068",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750153068",
            "telephone_number": "972-659-1234",
            "fax_number": "972-827-0195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 N HAMPTON RD",
            "address_2": "SUITE 120",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153903",
            "telephone_number": "972-283-0444",
            "fax_number": "972-283-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EMERGENCY SERVICE ASSOCIATION OF DESOTO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2013-10-28",
        "status": "A",
        "authorized_official_last_name": "ENNIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "972-659-1234",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EcCare Health Center of DeSoto",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2013; 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.