Provider Demographics
NPI:1568730836
Name:EMERGENCY ROOM MD LLC
Entity Type:Organization
Organization Name:EMERGENCY ROOM MD LLC
Other - Org Name:ER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-418-1999
Mailing Address - Street 1:46 HOLTSINGER AVE
Mailing Address - Street 2:APT G
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3574
Mailing Address - Country:US
Mailing Address - Phone:662-418-1999
Mailing Address - Fax:
Practice Address - Street 1:562 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2742
Practice Address - Country:US
Practice Address - Phone:662-779-5150
Practice Address - Fax:662-779-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty