Provider Demographics
NPI:1881683548
Name:PHOENIX EMERGENCY SERVICES OF MADISON LLC
Entity type:Organization
Organization Name:PHOENIX EMERGENCY SERVICES OF MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-751-1157
Mailing Address - Street 1:2828 CROASDAILE DR
Mailing Address - Street 2:PHOENIX EMERGENCY SERVICES OF MADISON
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2505
Mailing Address - Country:US
Mailing Address - Phone:877-751-1157
Mailing Address - Fax:
Practice Address - Street 1:1 KINGS DAUGHTERS DR
Practice Address - Street 2:PHOENIX EMERGENCY SERVICES OF MADISON
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3300
Practice Address - Country:US
Practice Address - Phone:812-265-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000380234OtherBLUE CROSS BLUE SHIELD OF IN
IN200540070 AMedicaid
KY2640517000OtherPASSPORT HEALTHPLAN ADVANTAGE HMO MEDICARE
KY78904984Medicaid
KY65944647Medicaid
KY50009161OtherPASSPORT HEALTH PLAN
IN200540070 AMedicaid
INDE0831Medicare PIN