Provider Demographics
NPI:1740239656
Name:MISS-LOU EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:MISS-LOU EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-712-2000
Mailing Address - Street 1:PO BOX 13316
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3316
Mailing Address - Country:US
Mailing Address - Phone:800-507-8874
Mailing Address - Fax:727-507-3630
Practice Address - Street 1:129 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5103
Practice Address - Country:US
Practice Address - Phone:601-445-6700
Practice Address - Fax:601-445-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449563Medicaid
MS01224710Medicaid
MS=========OtherTRICARE
MS01224710Medicaid