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NPI Code Detail

MEDICARE: JEFFERSON DAVIS EMERGENCY GROUP LLC

MEDICARE: JEFFERSON DAVIS EMERGENCY GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant
2363L00000XNurse Practitioner
3207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043289572
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFERSON DAVIS EMERGENCY GROUP LLC
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number : 800-893-9698
Fax Number :
Provider Business Practice Location Address
First Line : 1634 ELTON RD
Second Line :
City : JENNINGS
State : LA
Zip : 70546-3614
Country : US
Telephone Number : 337-616-7160
Fax Number :
Authorized Official
Title or Position : VP OF CONTRACTING
Name : LISHA C FALK
Credential :
Telephone Number : 337-609-1221
Provider Enumeration Date : 03/16/2006
Last Update Date : 03/23/2022

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