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NPI Code Detail

MEDICARE: JJ&R EMERGENCY GROUP OF TENNESSEE, P.C.

MEDICARE: JJ&R EMERGENCY GROUP OF TENNESSEE, P.C.
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 PhysicianG28196CA

General Provider Information

NPI Number : 1730130949
Entity Type Code : Organization
Provider Name (Legal Business Name) : JJ&R EMERGENCY GROUP OF TENNESSEE, P.C.
Provider Business Mailing Address
First Line : 1700 EAST WALNUT AVENUE
Second Line : #250
City : EL SAGUNDO
State : CA
Zip : 90245-2605
Country : US
Telephone Number : 310-301-2030
Fax Number : 310-306-5247
Provider Business Practice Location Address
First Line : 401 TAKOMA AVE
Second Line : EMERGENCY DEPARTMENT
City : GREENEVILLE
State : TN
Zip : 37743-4647
Country : US
Telephone Number : 423-639-3151
Fax Number : 423-636-2374
Authorized Official
Title or Position : PRESIDENT &CEO
Name : BARRY B. STAUM
Credential : M.D.
Telephone Number : 310-301-2030
Provider Enumeration Date : 05/12/2006
Last Update Date : 11/12/2008

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