Provider Demographics
NPI:1598973505
Name:EMILY J. STAPP MD
Entity Type:Organization
Organization Name:EMILY J. STAPP MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-282-2522
Mailing Address - Street 1:1572 PLANK RD
Mailing Address - Street 2:P. O. BOX 803
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4250
Mailing Address - Country:US
Mailing Address - Phone:812-282-2522
Mailing Address - Fax:812-282-3890
Practice Address - Street 1:1572 PLANK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4250
Practice Address - Country:US
Practice Address - Phone:812-282-2522
Practice Address - Fax:812-282-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN198750Medicare ID - Type Unspecified