1255380838 NPI number — PEARL 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 1255380838 NPI number — PEARL EMERGENCY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEARL 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:
1255380838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/11/2006
NPI Reactivation Date:
06/08/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19101-8349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-355-3818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E CULVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOX
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46534-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-772-6231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT, EPP
Authorized Official Telephone Number:
800-362-2731

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)

  • Identifier: 000000218446 . This is a "BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com