Provider Demographics
NPI:1801061858
Name:GARDNER STREET EMERGENCY PHYSICIANS
Entity type:Organization
Organization Name:GARDNER STREET EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOROSCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:800-732-1066
Mailing Address - Street 1:PO BOX 37721
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3607
Mailing Address - Country:US
Mailing Address - Phone:800-732-1066
Mailing Address - Fax:630-916-4333
Practice Address - Street 1:1451 N. GARDNER STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170
Practice Address - Country:US
Practice Address - Phone:812-752-3456
Practice Address - Fax:812-752-8576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty