Provider Demographics
NPI:1841222056
Name:AUGUSTA EMERGENCY PHYSICIANS, LTD
Entity Type:Organization
Organization Name:AUGUSTA EMERGENCY PHYSICIANS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-932-4465
Mailing Address - Street 1:ROUTE 636 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-932-4465
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 636 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-932-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA103308OtherBLUE SHIELD
VAC05350Medicare PIN
VAC01761Medicare PIN