Provider Demographics
NPI:1649229212
Name:TOMBIGBEE EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:TOMBIGBEE EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO EMCARE PHYSICIAN PROVIDERS, INC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:800-507-8874
Mailing Address - Street 1:PO BOX 13410
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3410
Mailing Address - Country:US
Mailing Address - Phone:800-355-3818
Mailing Address - Fax:
Practice Address - Street 1:1105 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5500
Practice Address - Country:US
Practice Address - Phone:662-256-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2011-03-02
Deactivation Date:2006-05-11
Deactivation Code:
Reactivation Date:2006-06-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherTRICARE
MS=========OtherBLUE SHIELD