Provider Demographics
NPI:1477532554
Name:PHYSICIANS IN EMERGENCY MEDICINE PSC
Entity Type:Organization
Organization Name:PHYSICIANS IN EMERGENCY MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUFFSTICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-361-9900
Mailing Address - Street 1:5454 NEW CUT RD
Mailing Address - Street 2:STE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4271
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-361-9947
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-361-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207P00000X, 207PS0010X, 363A00000X, 363AM0700X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN3684OtherRAILROAD MEDICARE
IN100025490AOtherMEDICAID
000000057678OtherANTHEM OF KENTUCKY
KY1061406OtherPASSPORT
029882600OtherFEDERAL BLACK LUNG
KY65919789Medicaid
KY65919789Medicaid
=========001OtherTRICARE
029882600OtherFEDERAL BLACK LUNG