1003081753 NPI number — WILLSTOWN EMERGENCY PHYSICIANS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003081753 NPI number — WILLSTOWN EMERGENCY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLSTOWN EMERGENCY PHYSICIANS
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:
1003081753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18167 US HIGHWAY 19 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33764-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-507-3633
Provider Business Mailing Address Fax Number:
727-507-3618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PAYNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35968-3458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
259-997-2305
Provider Business Practice Location Address Fax Number:
256-997-2507
Provider Enumeration Date:
04/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
800-507-8874

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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