Provider Demographics
NPI:1275558942
Name:MAPLE CITY EMERGENCY PHYSICIANS, LLP
Entity Type:Organization
Organization Name:MAPLE CITY EMERGENCY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLP MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-253-5358
Mailing Address - Street 1:75 REMIT DRIVE
Mailing Address - Street 2:SUITE 3309
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-3309
Mailing Address - Country:US
Mailing Address - Phone:800-701-3381
Mailing Address - Fax:239-939-1682
Practice Address - Street 1:1007 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3201
Practice Address - Country:US
Practice Address - Phone:219-326-1234
Practice Address - Fax:219-326-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200379990AMedicaid
IN193810Medicare PIN