Provider Demographics
NPI:1942263991
Name:CMH ER PHYSICIANS, LLC
Entity Type:Organization
Organization Name:CMH ER PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-447-3151
Mailing Address - Street 1:PO BOX 12039
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-2039
Mailing Address - Country:US
Mailing Address - Phone:434-774-2400
Mailing Address - Fax:434-774-2401
Practice Address - Street 1:125 BUENA VISTA CIR
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1431
Practice Address - Country:US
Practice Address - Phone:434-447-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013N4Medicaid
172719OtherANTHEM BC/BS OF VA
CJ8053OtherRAILROAD MEDICARE
23970OtherCHAMPUS
CJ8053OtherRAILROAD MEDICARE