Provider Demographics
NPI:1730130949
Name:JJ&R EMERGENCY GROUP OF TENNESSEE, P.C.
Entity Type:Organization
Organization Name:JJ&R EMERGENCY GROUP OF TENNESSEE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT &CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-301-2030
Mailing Address - Street 1:1700 EAST WALNUT AVENUE
Mailing Address - Street 2:#250
Mailing Address - City:EL SAGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2605
Mailing Address - Country:US
Mailing Address - Phone:310-301-2030
Mailing Address - Fax:310-306-5247
Practice Address - Street 1:401 TAKOMA AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4647
Practice Address - Country:US
Practice Address - Phone:423-639-3151
Practice Address - Fax:423-636-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28196207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734812Medicare PIN