Provider Demographics
NPI:1700815867
Name:ER PROFESSIONAL FEE BILLING C/O SLIDELL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ER PROFESSIONAL FEE BILLING C/O SLIDELL MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-649-8504
Mailing Address - Street 1:300 KITTY HAWK RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3906
Mailing Address - Country:US
Mailing Address - Phone:210-566-5555
Mailing Address - Fax:210-566-2287
Practice Address - Street 1:300 KITTY HAWK RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3906
Practice Address - Country:US
Practice Address - Phone:210-566-5555
Practice Address - Fax:210-566-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442038Medicaid
LA1442038Medicaid