Provider Demographics
NPI:1881754307
Name:EMERGENCY MEDICAL SPECIALIST
Entity type:Organization
Organization Name:EMERGENCY MEDICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-643-1073
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-0686
Mailing Address - Country:US
Mailing Address - Phone:706-643-1073
Mailing Address - Fax:706-643-1070
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-9180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty