Provider Demographics
NPI:1659366649
Name:EMERGENCY PHYSICIANS GROUP
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-9891
Mailing Address - Street 1:PO BOX 11407 DRAWER 0314
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0314
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:EM DEPT
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-9891
Practice Address - Fax:256-518-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF793OtherBCBS
ALCE9952OtherRAILROAD MEDICARE GROUP
AL310160500OtherDEPT OF LABOR OWCP
AL529500710Medicaid
AL310160500OtherDEPT OF LABOR OWCP