Emergency Medicine Doctor of Waco, PA

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

F9947 Issued in TX

Legal business name

EMERGENCY MEDICINE DOCTOR OF WACO, PA

Practice address

3721 Herwol Ave
Waco, TX 76710-7218

Phone

(254) 493-8337

NPI assigned

Jun 25, 2007

Organization subpart

No

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

Authorized official

Name

James Pettit, DONPI 1265450175

Title

Owner-President

Phone

(254) 752-9821

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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.

• James C Pettit, DO

  • Family Medicine Physician
  • Rockdale, TX
  • NPI 1265450175
  Medicare reassignment Authorized official
• Joann Bristol, LCSW

  • Clinical Social Worker
  • Waco, TX
  • NPI 1679609291
  NPD (past)

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1548466766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 HERWOL AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767107218",
            "telephone_number": "254-493-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 HERWOL AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767107218",
            "telephone_number": "254-493-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICINE DOCTOR OF WACO, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER-PRESIDENT",
        "authorized_official_telephone_number": "254-752-9821",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "F9947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167263601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven M Elwell, MD
• Kathryn M Emadi, M.D.
• Embrace Counseling PLLC
• Kristen Nicole Embry, ABA
• Chike Emejuaiwe
• M. Theresa Emerson, PSY.D.
• Carlos A Encarnacion, M.D.
• Endeavor Rehab Center Inc (Bosque River Physical Therapy)
• Lindon Sean Endsley, D.D.S.
• Isabella Engel, RBT

• Emergency Medicine Physician in Waco, TX
• Providers in Waco, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.