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NPI Code Detail

MEDICARE: ST MARY EMERGENCY GROUP LLC

MEDICARE: ST MARY 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
1207R00000XInternal Medicine Physician
2363A00000XPhysician Assistant
3363L00000XNurse Practitioner
4207P00000XEmergency 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
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235108499
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST MARY 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 : 1125 MARGUERITE ST
Second Line :
City : MORGAN CITY
State : LA
Zip : 70380-1855
Country : US
Telephone Number : 985-384-2200
Fax Number :
Authorized Official
Title or Position : VP OF CONTRACTING
Name : LISHA C FALK
Credential :
Telephone Number : 337-609-1221
Provider Enumeration Date : 03/17/2006
Last Update Date : 06/06/2022

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Directions to “ST MARY EMERGENCY GROUP LLC ” Practice Location

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