MEDICARE: INDIANA EMERGENCY PHYSICIANS, LLP

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
1	207P00000X	Emergency Medicine Physician
2	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1073949160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA EMERGENCY PHYSICIANS, LLP

Provider Business Mailing Address
First Line	:	75 REMIT DR
Second Line	:	SUITE 1122
City	:	CHICAGO
State	:	IL
Zip	:	60675-1122
Country	:	US
Telephone Number	:	866-916-5259
Fax Number	:	231-922-4030

Provider Business Practice Location Address
First Line	:	3300 POPLAR ST
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-2340
Country	:	US
Telephone Number	:	812-235-6281
Fax Number	:

Authorized Official
Title or Position	:	LLP MANAGING PARTNER
Name	:	DERIK K KING
Credential	:
Telephone Number	:	866-916-5259

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/20/2013

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