Provider Demographics
NPI:1316036973
Name:BATESVILLE EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:BATESVILLE EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORKERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-573-0386
Mailing Address - Street 1:314 WESTMORELAND CIR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8456
Mailing Address - Country:US
Mailing Address - Phone:601-573-0386
Mailing Address - Fax:662-563-2189
Practice Address - Street 1:107 EUREKA ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2533
Practice Address - Country:US
Practice Address - Phone:601-573-0386
Practice Address - Fax:662-563-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
MS12101261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02734Medicare PIN