Provider Demographics
NPI:1891741641
Name:LAFAYETTE EMERGENCY PHYSICIANS, INC
Entity Type:Organization
Organization Name:LAFAYETTE EMERGENCY PHYSICIANS, INC
Other - Org Name:BOONE COUNTY EMERGENCY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-447-6811
Mailing Address - Street 1:PO BOX 2306
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2306
Mailing Address - Country:US
Mailing Address - Phone:469-420-5527
Mailing Address - Fax:
Practice Address - Street 1:2605 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052
Practice Address - Country:US
Practice Address - Phone:214-506-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCN1219OtherRAILROAD
IN100464230Medicaid
INCN1219OtherRAILROAD