Provider Demographics
NPI:1609146554
Name:LITTLE RIVER EMERGENCY PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:LITTLE RIVER EMERGENCY PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-928-6268
Mailing Address - Street 1:PO BOX 30759
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-0013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-313-5245
Practice Address - Street 1:320 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:800-887-5762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALIGNMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-10
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty