Provider Demographics
NPI:1093201543
Name:RELIAS EMERGENCY MEDICINE SPECIALISTS OF FAYETTE, LLC
Entity Type:Organization
Organization Name:RELIAS EMERGENCY MEDICINE SPECIALISTS OF FAYETTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-635-8383
Mailing Address - Street 1:PO BOX 31485
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28231-1485
Mailing Address - Country:US
Mailing Address - Phone:662-432-4106
Mailing Address - Fax:
Practice Address - Street 1:1653 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1314
Practice Address - Country:US
Practice Address - Phone:662-432-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty