Provider Demographics
NPI:1659774032
Name:INDIANA EMERGENCY PHYSICIANS, LLP
Entity Type:Organization
Organization Name:INDIANA EMERGENCY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLP MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-916-5259
Mailing Address - Street 1:75 REMIT DR # 1122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1122
Mailing Address - Country:US
Mailing Address - Phone:800-210-7034
Mailing Address - Fax:
Practice Address - Street 1:1 SISTERS OF PROVIDENCE
Practice Address - Street 2:
Practice Address - City:SAINT MARY OF THE WOODS
Practice Address - State:IN
Practice Address - Zip Code:47876-1007
Practice Address - Country:US
Practice Address - Phone:812-535-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty