Provider Demographics
NPI:1720026826
Name:HOOSIER EMERGENCY PHYSICIANS LLC
Entity Type:Organization
Organization Name:HOOSIER EMERGENCY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TENNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-401-2386
Mailing Address - Street 1:PO BOX 13621
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3621
Mailing Address - Country:US
Mailing Address - Phone:469-401-2386
Mailing Address - Fax:
Practice Address - Street 1:2200 N SECTION ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7523
Practice Address - Country:US
Practice Address - Phone:812-268-4311
Practice Address - Fax:812-268-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000361474OtherBLUE SHIELD
IN200524970AMedicaid
IN=========OtherCHAMPUS/TRICARE
IN230030Medicare PIN
IN000000361474OtherBLUE SHIELD