Provider Demographics
NPI:1336673805
Name:TEAMHEALTH EMERGENCY MEDICINE SOUTHEAST GROUP
Entity Type:Organization
Organization Name:TEAMHEALTH EMERGENCY MEDICINE SOUTHEAST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD ADVANCED PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-220-2399
Mailing Address - Street 1:400 TAYLOR RD
Mailing Address - Street 2:SUITE 3380
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 TAYLOR RD
Practice Address - Street 2:SUITE 3380
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3512
Practice Address - Country:US
Practice Address - Phone:334-213-6255
Practice Address - Fax:334-213-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL363L00000X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital