Provider Demographics
NPI:1043315906
Name:EMERGENCY MEDICINE ASSOCIATES OF JACKSON
Entity Type:Organization
Organization Name:EMERGENCY MEDICINE ASSOCIATES OF JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-936-6001
Mailing Address - Street 1:PO BOX 16076
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-6076
Mailing Address - Country:US
Mailing Address - Phone:601-936-6001
Mailing Address - Fax:601-936-4389
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-936-6001
Practice Address - Fax:601-936-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015728Medicaid
MS09015728Medicaid