Active NPI
Stanislaw Bedkowski, MD
- Emergency Medicine Physician
- Tyler, TX
National Provider Identifier
1750370441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- K0630
- Practice address
- 11937 US Highway 271
Tyler, TX 75708-3154 - Phone
- (903) 877-3451
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | K0630 | TX | Primary |
Addresses
Primary practice location
11937 US Highway 271
Tyler, TX 75708-3154
Mailing address
PO Box 847824
Dallas, TX 75284-7824
Phone (903) 877-7777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110751803 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K0630 | TX | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243468800000",
"number": "1750370441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 847824",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847824",
"telephone_number": "903-877-7777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11937 US HIGHWAY 271",
"city": "TYLER",
"state": "TX",
"postal_code": "757083154",
"telephone_number": "903-877-3451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEDKOWSKI",
"first_name": "STANISLAW",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2009-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "K0630",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110751803",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.