Provider Demographics
NPI:1568401420
Name:EMERGENCY PHYSICIANS OF PORTLAND, PLLC
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS OF PORTLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:615-269-0652
Mailing Address - Street 1:2020 21ST AVE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4314
Mailing Address - Country:US
Mailing Address - Phone:615-269-0652
Mailing Address - Fax:615-269-0135
Practice Address - Street 1:105 REDBUD DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1673
Practice Address - Country:US
Practice Address - Phone:615-325-7301
Practice Address - Fax:615-269-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734968Medicaid
TN3734968Medicare PIN