MEDICARE: MISSISSIPPI EMERGENCY PHYSICIAN SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363A00000X	Physician Assistant
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1073856894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI EMERGENCY PHYSICIAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	300 S PARK RD
Second Line	:	SUITE 400
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8593
Country	:	US
Telephone Number	:	800-815-8377
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 RIVER OAKS DR
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-5375
Country	:	US
Telephone Number	:	601-855-4000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID SCHILLINGER
Credential	:
Telephone Number	:	877-693-5700

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	04/10/2014

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