Texas Em I Medical Services PA

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

TEXAS EM I MEDICAL SERVICES PA

Practice address

104 7TH St
Bay City, TX 77414-4853

Phone

(979) 241-3319

NPI assigned

Jan 17, 2013

Last updated

Sep 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William C Jernberg

Title

Owner

Phone

(214) 712-2000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1548508138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "SUITE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 7TH ST",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774144853",
            "telephone_number": "979-241-3319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS EM I MEDICAL SERVICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "JERNBERG",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-712-2000"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Bay City, TX
• Providers in Bay City, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; 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.