Provider Demographics
NPI:1245570332
Name:FORT MOUNTAIN EMERGENCY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:FORT MOUNTAIN EMERGENCY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-507-8874
Mailing Address - Street 1:PO BOX 37913
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-0510
Mailing Address - Country:US
Mailing Address - Phone:800-507-8874
Mailing Address - Fax:
Practice Address - Street 1:707 OLD DALTON ELLIJAY RD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2029
Practice Address - Country:US
Practice Address - Phone:706-517-2057
Practice Address - Fax:706-517-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty