Provider Demographics
NPI:1952554651
Name:NORTHWEST TENNESSEE EMERGENCY PHYSICIANS, LLP
Entity type:Organization
Organization Name:NORTHWEST TENNESSEE EMERGENCY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-253-1795
Mailing Address - Street 1:75 REMIT DR
Mailing Address - Street 2:STE 3235
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-0001
Mailing Address - Country:US
Mailing Address - Phone:866-217-3881
Mailing Address - Fax:205-313-5245
Practice Address - Street 1:214 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9737
Practice Address - Country:US
Practice Address - Phone:901-516-4000
Practice Address - Fax:205-313-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty