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NPI Code Detail

MEDICARE: EASTERN EMERGENCY PHYSICIANS LLC

MEDICARE: EASTERN EMERGENCY PHYSICIANS 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
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3207R00000XInternal Medicine Physician
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

General Provider Information

NPI Number : 1982653564
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN EMERGENCY PHYSICIANS LLC
Provider Business Mailing Address
First Line : 13737 NOEL RD
Second Line : STE 1600
City : DALLAS
State : TX
Zip : 75240-1331
Country : US
Telephone Number : 469-401-2386
Fax Number :
Provider Business Practice Location Address
First Line : 865 STONE ST
Second Line :
City : RAHWAY
State : NJ
Zip : 07065-2742
Country : US
Telephone Number : 732-381-4200
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. RUSSELL HARRIS
Credential : MD
Telephone Number : 469-401-2386
Provider Enumeration Date : 05/09/2006
Last Update Date : 12/23/2013

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Directions to “EASTERN EMERGENCY PHYSICIANS LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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