Provider Demographics
NPI:1497725873
Name:EMERGI-TRUST
Entity Type:Organization
Organization Name:EMERGI-TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-476-6889
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-0966
Mailing Address - Country:US
Mailing Address - Phone:877-346-2211
Mailing Address - Fax:626-623-1227
Practice Address - Street 1:4321 CAROTHERS PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5909
Practice Address - Country:US
Practice Address - Phone:855-302-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4061460OtherBCBS GROUP PROVIDER
TNDA3956OtherRAILROAD MEDICARE GROUP
TN3717174Medicaid
4061460OtherBCBS GROUP PROVIDER