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NPI Code Detail

MEDICARE: GRANDALE EMERGENCY PHYSICIANS

MEDICARE: GRANDALE EMERGENCY PHYSICIANS
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
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1710936760
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANDALE EMERGENCY PHYSICIANS
Provider Business Mailing Address
First Line : PO BOX 41579
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19101-1579
Country : US
Telephone Number : 800-507-8874
Fax Number : 727-507-3630
Provider Business Practice Location Address
First Line : 1500 LEE BLVD
Second Line :
City : LEHIGH ACRES
State : FL
Zip : 33936-4835
Country : US
Telephone Number : 239-368-4410
Fax Number : 239-368-4420
Authorized Official
Title or Position : VICE PRESIDENT
Name : TERRY MEADOWS
Credential :
Telephone Number : 800-507-8874
Provider Enumeration Date : 05/08/2006
Last Update Date : 08/22/2020

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Directions to “GRANDALE EMERGENCY PHYSICIANS ” Practice Location

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