Provider Demographics
NPI:1487866380
Name:KENNETT EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:KENNETT EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-732-1066
Mailing Address - Street 1:PO BOX 37637
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-7637
Mailing Address - Country:US
Mailing Address - Phone:800-732-1066
Mailing Address - Fax:
Practice Address - Street 1:1301 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2525
Practice Address - Country:US
Practice Address - Phone:573-888-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220031OtherBLUE SHIELD
MO=========OtherCHAMPUS/TRICARE
MODG1730Medicare PIN