1134119688 NPI number — EMERGENCY PHYSICIAN ASSOCIATES, PA

Table of content: (NPI 1134119688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134119688 NPI number — EMERGENCY PHYSICIAN ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIAN ASSOCIATES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134119688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21705-0730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-631-9191
Provider Business Mailing Address Fax Number:
301-631-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W SEVENTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-566-3330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-662-2480

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H733 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K055 . This is a "BCBS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0006578000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 762671100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000845445 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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