1285686675 NPI number — EMERGENCY PHYSICIANS INC

Table of content: ALICE EDMONDS (NPI 1467597948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285686675 NPI number — EMERGENCY PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIANS INC
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:
EMERGENCY RESOURCES GROUP
Provider Other Organization Name Type Code:
3
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:
1285686675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 PRUDENTIAL DR
Provider Second Line Business Mailing Address:
713
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32207-8210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-396-5682
Provider Business Mailing Address Fax Number:
904-346-0864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PRUDENTIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-396-5682
Provider Business Practice Location Address Fax Number:
904-346-0864
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STROMBERG
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
MILES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-396-5682

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: 98314 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com