Provider Demographics
NPI:1417956384
Name:EMERGENCY PHYSICIANS OF DELAWARE COUNTY, P.C.
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS OF DELAWARE COUNTY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-969-1950
Mailing Address - Street 1:3620 N EVERBROOK LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5200
Mailing Address - Country:US
Mailing Address - Phone:260-969-1950
Mailing Address - Fax:765-741-1424
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:260-969-1950
Practice Address - Fax:765-741-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004368A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100104590AMedicaid
IN000000101121OtherBLUE CROSS/BLUE SHIELD
IN128786100OtherDEPARTMENT OF LABOR
IN=========001OtherTRICARE
IN203170Medicare PIN